Senjuti Saha: public health researcher from Bangladesh reflects how gender and global inequities impact research
The Spotlight series is an interview-based profile series by McGill Global Health Perspectives. The series focuses on researchers and practitioners in global health outside of high-income country settings (and) or representing marginalized groups. For our second spotlight profile, we are featuring Dr. Senjuti Saha of Child Health Research Foundation of Bangladesh.
Dr. Senjuti Saha, who grew up in Bangladesh, completed her doctoral studies in molecular genetics at the University of Toronto. She is a leading scientist, trainer, and director at the Child Health Research Foundation (CHRF), where her team focuses on research to improve child and maternal health in Bangladesh. In 2020, she was awarded “Anannya Top 10 Women” in Bangladesh and was noted as “Heroes in the Field” by Bill Gates. While the foundation’s research focuses on diseases such as meningitis and genomic surveillance, their expertise in sequencing also has made them a vital part of Bangladesh’s COVID-19 response. CHRF was the first to sequence the SARS-COV-2 in Bangladesh and the first non-government lab to start COVID-19 testing.
Can you tell us a bit about your background and what led you to become a researcher?
Senjuti Saha at Child Health Research Foundation, Bangladesh
As my parents were in India completing their PhDs in microbiology, I initially grew up with my grandparents until I was almost 4 years old. However, when my parents came back to Bangladesh and got actively involved in public health, I ended up growing up in a household where public health was heavily discussed, and that sparked my interest in sciences and public health. I have always been immersed in dinner table conversations around science, infectious diseases, and health. Even after school, I would either end up at my mom’s vaccination lab or my dad’s diagnostic lab. So, I was very interested and passionate about science. Following my passion, I applied for higher studies in Canada without even telling my parents, and I secretly used my dad’s credit card to pay the application fees for undergraduate studies in Canada. That is how my journey towards becoming a microbiologist started.
How did the experience in Canada impact your life and your interests?
In Canada, I experienced more freedom than I did at home. As a woman, I felt more independent even when doing basic things like riding a bike or being able to freely navigate the city alone. Also, as I was diagnosed with cancer when I was 24 years old, being in Canada allowed me to access healthcare for free under insurance. This was a huge factor because in Bangladesh – as in many low- and middle-income countries (LMICs) – I might not have received the diagnosis and/or care I needed and traveling to a different country for cancer treatment might have been unaffordable for our family. It felt like a second chance at life. I completed my undergraduate degree and my doctorate in Canada. Yet, there was this nagging question within me about giving back and I kept asking how my research will ever reach the communities I care about in Bangladesh?
Yes, so how did you find a way to reach communities in Bangladesh. What was that process like?
The main reason for going back stemmed from my effort in finding meaning in my work, coupled with me wanting to contribute to the community that I am from. So, I decided to initially go back to Bangladesh for just one year in 2016– and that year has not ended yet, and hopefully never will. The transition was not easy, and I had to just work first to learn the system and the processes. I started by working alongside my father but then I ventured further into my interest in maternal and child health focusing on genomic sequencing to identify pathogens. As I delved more into research, the more I felt the need to stay back and support the work here in Bangladesh.
While your work is making a difference in Bangladesh, it is often difficult to manage these transitions and they often come at personal costs. Can you talk about these personal level challenges that you faced?
I think these experiences differ by person. For me, I had two major challenges. First, was my own health. Moving back to Bangladesh meant losing the healthcare I was used to for my cancer treatments. However, I wanted to use the second chance in life I got, to do what I thought was most meaningful. So, it was important for me to find ways to manage and make this move. Second, as I got married while in Canada, moving countries also meant moving into a long-distance relationship and making a sacrifice in order to pursue our professional goals. While my husband and I remain very supportive of each other’s decisions, these decisions do come at a cost for both of us.
These sacrifices while difficult must also mean you really find value in the work that you are doing. Can you expand on what your current focus is and how it affects health in Bangladesh?
Currently, I have two main focus areas.
The first is understanding what causes diseases in countries like Bangladesh. Our diagnostics, the way we look for pathogens and a lack of laboratory infrastructure have caused a huge gap in what we know about the pathogens that cause diseases. In 2009, Bangladesh introduced a vaccine for Haemophilus influenzae type b (Hib). Hib causes some severe forms of pneumonia and meningitis. So, until my father did research and generated evidence that this pathogen existed in Bangladesh, the country (or even South Asia) did not know it existed and did not know to vaccinate against it. Learning from that what I try to do is create an atlas of pathogens affecting us. We use a method called unbiased RNA metagenomic sequencing to find what are the pathogens that cause diseases whether it is meningitis, pneumonia, sepsis, or anything else. It started very small, when I arrived there was no genomic facility in the country. So, in the first couple of years, I had to figure out how to get the infrastructure set up from the equipment, processes, and how to get funding. But now, I would say we have one of the biggest, if not the biggest, genomic facilities, productivity-wise in the country. We have a big team now, and we are branching out, starting to provide commercial services at a low cost for other scientists. So, we have our own research component, we are trying to help other scientists in the country and also act as a training facility in the country as well. And we were able to significantly help during the COVID-19 pandemic by quickly starting SARS-CoV-2 genomic surveillance and aiding the country with bioinformatics as well.
The second is where we try to understand the indirect impact of vaccines or lack of vaccinating. What we have realized is that policymakers make decisions based on data on deaths. In a way, we are still stuck in the millennium development goal era. When we tried to introduce the vaccine for rotavirus, a virus that causes hospitalization due to diarrhea but not death with optimal treatment – there was hesitancy among policymakers as it does not cause death. So, what we have tried to show to policymakers and others is that even if a disease does not kill, it can put a tremendous amount of pressure on the health system. We used the case of hospital beds and showed that diarrhea might not kill but diarrhea takes up a lot of beds in the hospital and our beds are limited. So, we used our hospital, Bangladesh Shishu Institute and Hospital (previously known as Dhaka Shishy (Children’s) Hospital), as an example. We admit around 23,000 but we had to refuse close to 6,000 due to lack of available beds. These children that are often rejected are extremely sick, need immediate care and travel from far areas of the country. However, by the time they arrive all beds are already full, many of which are taken up by a vaccine-preventable disease. So, I am leading this effort to understand how vaccine-preventable diseases can have an impact on outcomes of other diseases or how a vaccine can prevent diseases and make space for non-preventable diseases within the health system.
Since health systems are impacted by the pandemic, can you speak to the impact of COVID-19 on the health system, the impact of having or not having vaccines?
COVID-19 itself is very bad. It impacts the health of the population, but it is also taking away attention from other diseases. For example, we are fighting a dengue outbreak this year. With the pandemic, there were changes in health seeking behaviour and health care provision behaviour. For example, if a newborn tested positive for COVID-19, they might not have received the necessary surgeries for congenital anomalies at the beginning of the pandemic. Therefore, many children who were in neonatal care died because they tested positive without any symptoms and did not receive care. This is why COVID-19 vaccines are so important; when a vaccine comes to resource constraint settings, the impact is so much more than in resource rich settings! Because it is freeing up resources, saving lives, helping people go back to work, indirectly helping people to get out of debt – there are substantial indirect impact of vaccines here when compared to resource rich settings.
Earlier you touched upon the challenges of transition. You spoke of the challenges of being young, a woman and other challenges. Would you like to expand?
Upon returning to Bangladesh, because women empowerment is still a growing movement, I faced challenges as a woman, and I continue to face them; however, the challenges are evolving. I hear these terms such as “oh, she is just a baby” phrases that usually men do not have to face. Also, my father works in the same field. So initially there were comments such as “oh, his daughter” and “she is just here for fun” or “she should go back to her husband.” These comments get to you, but I cope with the amazing family support I have. Also, in our culture, it is not “nice” to live away from your husband. So, some of the major questions were “how could you leave your husband and come here?” and “what is he going to eat?” because according to many I was not fulfilling my role as a “good” wife. Even some of my mentors in Canada expressed these sentiments. When first told of my decision to go back, the first thing they asked was “will you be leaving your husband?” Their first concern was not about my research or funding but my husband, which was something I had to get used to especially once I returned.
I’m not the only one facing challenges. It is 9.30 PM now and I have female lab members who are still working. I see the difference in their lives compared to their male co-workers. For example, when a girl goes home, she is expected to cook, clean, and get lunch ready for the next day; but when a guy goes home, he is able to get on Zoom with other colleagues or me, prepare for the next day’s experiments, etc. Women are expected to leave our work the second we step out of our offices or labs. So, there are imbalances.
This is only one aspect of the challenges, as I have learned. I know you are also facing challenges when trying to push forward research in a low- and middle-income country due to inequity. Can you expand on those challenges?
I would say we have three major challenges. First is the lack of access to resources. Lack of access to resources is a problem in itself, but it also impacts the time that we have to start and finish research. As experiments and results get delayed, we lose opportunities to explore our scientific ideas and hypothesis. For example, a reagent that would be available within 24 to 48 hours in a high-income country setting, might take 48 days to reach our lab in Bangladesh. Also, the costs are higher, due to companies not having branches and researchers having to use third parties. In a setting where there is less funding and low currency value, it is counter-intuitive for the costs to be higher, but they are. This especially impacts young scientists who have high levels of motivation and excitement over scientific experiments they had planned but are not able to complete them due to delays and cost of these resources. So, these delays and lack of access result in wasted time and blunted motivations. It also affects our ability to produce cutting-edge research – as we wait for reagents or primers sometimes for months, someone else would have the same idea and complete the experiment.
Second, we are “scholarly poor.” What I mean by scholarly poor is that we have to pay to publish and pay to read – and we do not have sufficient funds to do either. I work for an NGO, and we don’t have funds to subscribe to journals and cannot access articles behind paywalls. It is better with Sci-Hub but still, it is a huge, huge barrier. Then we have to pay to publish, sometimes the fee to publish costs more than the research itself. So, being scholarly poor is a significant challenge for researchers in low and middle-income countries.
The final challenge is the challenge of language. I am privileged that I speak English and that I got to spend time in Canada. A significant part of the population in Bangladesh, either do not speak English, or it is not the same as speaking your mother tongue. We used to conduct many of our meetings in English, as we wanted everyone to learn English – a bit of a colonial mindset. So, I saw even people who were super-excited about the project, did not ask many questions and were not participating. So, we did this survey asking structured questions around “would you come to meetings and participate if the language was different?” And many said not only would we come to meetings but also read the work published by our organization. So overnight we changed our policies, and everything is now in Bangla. In meeting rooms where there were empty chairs when meetings were in English, now people come and sit on the floor – because it is in Bangla. They do so because they understand what is being said and they can express themselves clearly when presenting. I am telling this story because you can imagine the challenges people face when accessing scientific literature. As researchers, our currency is publishing and keeping up with literature – and language can be a huge barrier and we need to address that. Journals should at least have a method of publishing articles in the language of the country where the data is from, and where the data can actually be used to make a difference.
These are only some of the challenges we face every day as researchers, but there are many more. There is still a lot to do to bridge these gaps and move public health research forward.
Senjuti Saha Tweets at @senjutisaha
About the Author(s):
This is a collective effort of the McGill Global Health Perspectives Team. Maryam Parvez and Shashika Bandara led the interviewing and the writing for this conversation with Senjuti Saha.