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Bringing child care from Afghanistan to King's

The challenges to providing care to women and their babies differ greatly between the UK and countries affected by war or with isolated communities cut-off from mainstream healthcare. Professor Karen Edmond is soon to join King’s School of Life Course Sciences as Professor of Child Health and has experienced this first hand while based in Kabul working as the United Nations Children's Fund (UNICEF) Chief of Health for Afghanistan.

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Here, she talks about about her career experiences to date and how she hopes it will shape her work at King’s:

How did your career start?

From an early age I had the inclination to care for the vulnerable and I think this came from my family, where I saw up close the challenges of mental illness and the vulnerability it creates. Looking back, this is why I chose a career in medicine. I decided I could solve problems that make things better for the most vulnerable people.

What did you most want to achieve?

Throughout my career, I have worked to improve primary care for the largest number of disadvantaged children possible. But, I have found it particularly shocking that there is lack of primary care for disadvantaged women and children in rich countries with seemingly excellent healthcare. My first experience of this was the ten years I spent working with Aboriginal communities in Northern and Western Australia.

These communities are geographically isolated, marginalised and disenfranchised. Colonial history, racism, loss of ownership of land and culture all play their part. Alongside high rates of communicable diseases – like pneumonia and diarrhoea - there are many babies born malnourished, to mothers with poor mental health or substance addiction. I set out to design interventions and create ways of getting healthcare to reach the most disadvantaged mothers on the continent.

This led quite naturally to my ‘second life’, working internationally for the WHO in Geneva, the London School of Hygiene & Tropical Medicine in Ghana and later for UNICEF in Afghanistan. The big challenges to newborn survival across the world have remained the same: prematurity, infection, breathing difficulties during and after labour. Reducing these has been my priority alongside improving neurodevelopment and nutritional outcomes.

What were the big difficulties of working in Afghanistan?

Personally, I’ve never felt significantly scared or anxious living and working in Afghanistan. The UN processes in place are robust and promote the immediate implementation of care and UNICEF have a large team of first class staff.  

The biggest challenge is access. Lots of international development focuses on big, high-tech, complex hospitals which are excellent but not much help to remote communities isolated by conflict. My main goal was to shift things towards mobile, community health workers who can navigate the warzones to reach those hardest hit.

Many countries in conflict don’t have mobile health teams, which seems crazy to me. Research has shown how effective they are and my hope for the next few years is to strengthen the evidence and make the case for more projects to take this approach.

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What has most surprised you during your time there?

The local doctors and nurses are highly-skilled and incredibly positive. It’s not that they don’t know how to treat patients, they just lack the facilities and supplies to do so. Many Afghani health workers have been trained elsewhere and this created an incredibly rewarding and productive environment for my team, as there was a pool of talented people to call upon.   

How are things changing?

It is still a deeply conservative country but there is a growing movement towards women’s freedom particularly in higher socio-economic society. There are inspirational women teachers, doctors and nurses who are working across Afghanistan today and I think their contributions are largely ignored by the outside world. There is also an incredible kinship between women that I would never have seen if I were a man. Although many women do wear a veil in public, the burqas all come off as soon as the men leave. Things then feel like any other mother and baby group I have been part of, with women sharing stories, asking advice and passing their babies back and forwards. 

And finally, what are your plans here at King’s?

King’s is going give me the opportunity to work from the laboratory to community, supporting mothers, children and care providers directly.

One important example of the work I hope to push forward, is home visits for new mums and babies. These visits offer support during a particularly stressful time and have been shown to benefit babies and protect women’s mental and physical health. Such interventions may not be glamorous and so are often first to go when funding gets squeezed but I aim to help to prove just how essential they are.

It’s my sincere hope that I can build on the hard work that has gone before in the Department of Women & Children’s Health to continue as leaders in epidemiology, population health and service delivery.

Watch this space!