The Royal Swedish Academy of Sciences has elected Dr. Ashish KC for the SIGHT Award 2021 of SEK 100,000 for his work in strengthening the quality of maternity and infant care in low-and-middle-income countries (LMIC).
By Ulrica Segersten/Alexander Farnsworth
Dr. Ashish KC is honored to receive the SIGHT Award 2021. “It encourages and aspires me to work even harder, to do everything I can to help pregnant women, the unborn and the newborn have a better start in life,” he says.
Dr. Ashish KC is originally from Kathmandu, Nepal and he feels humbled to be in the company of previous prize winners within the Royal Swedish Academy of Sciences. That he became associate professor at the Department of Women’s and Children’s Health at Uppsala University, with a commitment to the care of newborns, is attributable, he says, to his mother.
“She was a nurse and midwife who trained traditional healthcare workers in maternity care in the Nepalese countryside. I would accompany her sometimes on two-day walking trips into the mountains. This experience gave me a whole different perspective on healthcare,” says Dr. Ashish KC.
“Healthcare is so much more than hospitals. As a trained pediatrician, I wanted to give back to society – more than just having a great job and a doctor’s life – I wanted to understand the root cause of ill health among mothers and newborns.”
An academic storyteller
Dr. Ashish KC has earlier worked with Save the Children and Unicef in Nepal and implemented several major clinical-based studies there.
“I realized early on that if you want to improve anything, the medical, scientific and methodological stories about mothers’ and newborns’ health are vital to disseminate and understand,” he says.
A cascade of stories
“When I met pregnant women in mountain villages in Nepal, women who had thousands of questions about their pregnancy and childbirth, but who never received proper answers, it created such a relief and sense of security when we could give them clear guidelines. It is a mission that goes deeper than almost anything else,” he says, proudly.
Litmus test for health care
According to Dr. Ashish KC, the pandemic has become a litmus test for measuring the accessibility of healthcare for mothers and newborns around the world, especially in low-and-middle-income countries (LMIC). Yet globally, mortality among unborn and newborns has dropped significantly over the past 20 years.
During the COVID-19-pandemic, Dr. Ashish KC conducted a maternity-related research at nine public hospitals in Nepal to monitor maternity care, infant mortality, and the proportion of hospital births versus non-hospital births. During the pandemic, his research team followed up to see how lockdowns in Nepal affected these maternity care issues.
“It turned out that 52.4 percent of the pregnant women in the study did not seek care, and 50 percent of those who did get care had severe complications because they came in late. A lot of this centered around the lack of proper transportation. Newborn mortality was three times higher than before the pandemic and we saw a 50 percent higher proportion of stillborn children. It was not the virus itself that became life-threatening, but the consequences of a dysfunctional healthcare system,” he says.
According to a study, published in The Lancet (Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study, August 10, 2020), the proportion of mothers who breastfed their children also fell. What did significantly improve during the pandemic however was employee hand hygiene, the study cites.
“It is clear from this that women were the hardest hit during the COVID-19-pandemics, they were the most exposed and gave birth at home to a greater extent. The health gap grew further during the pandemic which intensified the chaos in an already chaotic system,” says Dr Ashish KC.
The role of women at home and in society
When it comes to maternity care, the tools to improve quality and save more lives are not so complicated, claims Dr. Ashish KC. Instead, it is accessibility, healthcare systems and governance, and the stature of women in society and at home that adversely affects their situation. These, along with bad infrastructure, low access to electricity and poor working conditions for midwives and health care employees, are the roadblocks facing pregnant women and their newborns.
Taking a different tact, Dr. Ashish KC is convinced that childbirth would look very different if men were the ones giving birth, or if men could be midwives in more places in the world. Or if more politicians gave birth under the same conditions as ordinary citizens. New mothers and midwives are often too far removed from a decision maker’s reality.
“Maternity care is a revealing test of how equal a country is,” he says.
Climate change is the next health disaster
Perhaps the biggest challenge in the future is how climate change will affect the health of pregnant women and newborns.
This complicates matters in terms of the tools that are available.
“My medical education and experience are not sufficient to tackle the climate issue,” says Dr. Ashish KC, who has just been admitted to the SIGHT Fellows Programme, an interdisciplinary leadership program in global health, which he will attend with 10 other researchers from widely different disciplines and universities in Sweden.
“It’s like going back to school all of a sudden, but I am looking forward to interdisciplinary collaborations. It is absolutely necessary to create more tools in the face of the challenges that climate change in particular will pose to global health,” he says.
Dr. Ashish KC compares the SIGHT Fellows program to a beautiful cake that is made to represent global health, where slices represent the different scientific disciplines that are required for the whole to be understood, where new tools for change would be developed.
“My point is that women die unnecessarily for reasons other than medical ones. That’s why this collective cake of knowledge is needed, with results from brilliant researchers in biology, environmental medicine, epidemiology, microbiology, physics, human rights, chemistry and so on.”
The eleven researchers admitted to the SIGHT Fellows program will receive leadership training and will each be matched to international mentors with the goal of transforming global health.
What is good leadership in a time like this, Dr. Ashish KC?
“A leader is a person who is accepting and supportive of others; he or she listens and speaks last. Many people think that Swedish researchers and academics are shy and reserved, but I think they are good leaders. I want to be the one who listens and learns from others,” he says.
Where will you be in ten years’ time, Dr. Ashish KC?
“In ten years, I will have extensive interdisciplinary collaborations all over the world and a large network of colleagues in various scientific disciplines. This web, and every vibration in it, will help us understand global health – and what needs to be done. I hope that Sweden will become a global health hub where both epidemiology in combination with climate change science, societal development, physics, technology, economics and so on, can create clearer tools to prevent future health disasters.”
Dr. Ashish KC uses the analogy of bridge-building. Communities on either side of a deep river have much to gain from building a bridge, for example. The bridge is an indirect investment in health. Equal health requires functioning infrastructure, transportation solutions and a sustainable energy supply such as electricity. Clean and simple energy (sun) even in the most remote places could be “game changing” for health, believes Dr. Ashish KC.
“Imagine hot delivery rooms without working air conditioning, where the midwife has already worked for 8-9 hours, and it has become dark due to power outages when the mother giving birth after long hours traveling on rough roads arrives with increasingly intense pain. You get the idea.”
Postpartum depression is on the rise
Communicating stories is important to Dr. Ashish KC, but he continues to emphasize the importance of scientific evidence as well. One example is his research into postpartum depression where his group has shown that women who experience a low degree of autonomy are also more prone to depression, especially now during the pandemic.
“Postpartum depression is also dangerous for children. Women with postpartum depression tend not to breastfeed their babies. We have seen that during the pandemic, one in five women has suffered from postpartum depression. This means that every fifth newborn has a depressed mother and this threatens children’s health,” he says.
Dr. Ashish KC strongly believes that a key issue in global health is that women lack empowerment both at home and in society. Given how much women’s empowerment affects health both in the short and long term, this needs to change, he claims. There are also lessons to be learned from both Nepal and India where women networks outside of the healthcare sector have identified women at risk of postpartum depression. These networks ensure that women receive help while working to reduce the social taboos that exist around mental health and among new mothers.
And what makes you really angry, Dr. Ashish KC?
“Maybe not angry, but I get very sad when people continue to live in ignorance even though we have such great challenges and problems to solve. And often, we also know what needs to be done. This requires that we combine the various tools available. But, as soon as multidisciplinary collaborations are required, often the impetus for investing quickly disappears,” he says.
Dr. Ashish KC believes that the SIGHT Fellows programme is a good example of how different competencies and scientific disciplines are brought together to find solutions to major challenges.
“I think that people in power with large resources should see the benefits and what support it could be for decision-makers to make wise decisions. This should happen on a much larger scale, and also be supported by governments,” believes Dr. Ashish KC.
And what makes you happy, Dr. Ashish KC?
“I had a conversation this morning with a field worker about how lives could be saved. With simple teaching materials, we can concretely help people improve care for mothers and their newborns. After all, you can have as many resources as you like, but the greatest satisfaction is in reaching out to midwives with knowledge about how newborns’ lives can be saved by simple means,” he says.
“Yes, … and then all the conversations with my wife about how we should contribute to a more equal world, and when I manage to tell my daughters what I do during the day so that they also understand. That makes me really happy!”
Dr. Ashish KC in brief:
Dr. Ahish KC, 39, raised in Kathmandu, Nepal
Recipient of the SIGHT Award 2021. The jury’s motivation:
Family: Wife, a midwife and co-researcher for five years, two daughters, 5 and 10 years old. “My greatest pride in life is being the father of two daughters.”
Free time: “Discuss scientific and equality issues with my wife, especially since these were never emphasized in our past.”
Favorite subject: “Reading about history to understand the future. Fond of Hans Rosling’s books and his ‘ethical compass.”
Role model: “I greatly admire my mentor, Professor Emeritus Uwe Ewald, as a colleague and person. I can always turn to him. He does not always give me advice, but he makes me reflect.”
Work history: Associate Professor at the Department of Women’s and Children’s Health at Uppsala University. Dr. Ashish KC has worked with several different interventions to improve the immediate care of newborns, leading to better health and survival. Following his dissertation in 2016, Dr. Ashish KC established a research institute in his home country Nepal and built a broad international network. His studies on how the quality of maternal and child health care in low-resource environments was rewarded earlier this year with Uppsala University’s Oscar award.
Ashish KC is one of 11 researchers in the SIGHT Fellows Program 2021–2023.
SIGHT Award 2021:
The prize, which was founded with support from the Einhorn Family Foundation in 2017, will be awarded on November 25 during the student event Global Health Night & SIGHT Award 2021 at KTH in Stockholm.
Prize citation:
”For his dedicated research and implementation work to reduce the risk of injury and increase survival for newborns, children, and mothers in low- and middle-income countries.”
In connection with the award ceremony, a seminar will be held for students with a panel discussion on whether technology can be a good force for solving planetary health. (“Technology: A force for good in planetary health?”)
”For his dedicated research and implementation work to reduce the risk of injury and increase survival for newborns, children, and mothers in low- and middle-income countries.”
