First read: Prayaag Akbar’s debut novel ‘Leila’ is a fantasy of the near future

Walls have come up everywhere. Communities are boxed in. A daughter has been lost.

My husband thinks we cannot find her. His voice is raw from screaming. “When will you understand, Shalini? It’s been sixteen years.”

“You think I don’t know? Let’s get on with this.”

Riz looks at me, bobbles his head but doesn’t say anything. In the sinking light his old-man stubble glitters like salt grain. It is he who doesn’t understand. I’m almost there.

As we walk from the broad pavement to a small rectangle of grass he pulls out two candles from the satchel. Purity One, first of the sector walls, stretches out across us to the edges of the dusk, either end into the swirling ash. Gritty grey brick. Sixty feet high. Wrapping around the political quarter, sealing off the broad, tree-lined avenues, the colonial bungalows, the Ministries, the old Turkic gardens. The Council oversees the divided city from the political quarter, from behind Purity One.

Standing where we are now the wall is shimmering. Broad iridescent streaks, shifting in the way green and brilliant purple dance on the throat of a pigeon. (Pigeons infest this place.) Purity One is believed to have an inscrutable power. People come here to pray and plead. Take my own situation. I should be standing alone, yet here Riz is, by my side, etched sharp against the dusk as anything around us.

Not far from where we are there is a small room, abutting the wall. On the roof a white flag flutters the Council’s insignia, black pyramid, white tip. Hundreds of people shoulder past each other to get to this room. In the great heave all we see is a trapezoid of blue light where the double door extends above the devotees. A cage-like barrier divides the room; behind the wire squares is the holiest part of the wall, centre of the lowest line of bricks, painted ochre-like red. They worship this brick. They call it the first brick of Purity One.

Riz knelt to dig a hole in the earth. His back is badly hunched. Once there was a curving furrow of pebble-like muscles under each shoulder blade from hours every day on the squash court, but now, bent over the ground, he looked like a tortoise retreating into its shell.

I got down beside him, creaky myself.

“These are different candles,” I said, rolling one about my palm. Thicker, a spiral design wrapping neatly around the white wax.

“I found them near work. More expensive, but what the hell. It’s her birthday.”

He gave a tired smile.

“Smell them. I think she’d like this smell.”

We come to the wall every year on Leila’s birthday.

A karate teacher waddled a file of white-kitted children to an emptier stretch along Purity One. Within touching distance of the wall they stopped and bowed. A woman in a sequinned burqa was talking quietly with her daughters. One of the girls was in a purple headscarf with a scalloped hem, while the younger, perhaps not of age, was dressed in a T-shirt and tiered skirt. They inserted prayers written on scraps of paper into gaps between the bricks.

We brought out a plastic shovel from Riz’s bag. Along the yellow scoop the plastic had frayed and turned pasty white. The shovel was part of a set we’d bought Leila before a beach holiday. There was a sticker on the bucket, of a bear sliding down a rainbow, that she’d pick at. We bring the shovel every year but it’s too blunt, too flimsy for the dry, tight soil of this patch facing Purity One, the real work is done with our fingers. Soon we had holes two inches deep. We stood our candles in the earth. Packed the cavities with soil. Twenty minutes we sat and around us a scatter of bent and blacked sticks grew as the wind time and again guttered out the candles.

Purity One is the only sector wall that’s not impossibly filthy.

Everywhere else the stench is overwhelming, it hits you in the stomach. But no one seems able to do anything. Sometimes you see Slummers wading through the garbage, looking for things to sell.

A huge cheer went up. Two young men were visible above the thicket of heads, attempting the wall. They wore only white nylon basketball shorts with oilskin pouches tied at their chests, moving with upward pounces at unnerving speed, backs, calves, arms twitching and tensing, bodies bending double and right around like jackknives. One of the men was very dark-skinned. The other had a tuft of hair in the middle of his back. With the tips of fingers and bare toes they’d get a hold in the minute crannies and ledges between the uneven bricks, swinging higher all the time. The mob hummed with reverence.

“How strong, to leverage their bodies this way,” I said.

“It doesn’t seem possible,” Riz replied. “This sheer face. How are they doing it?”

“Why not. Like those guys who pull giant chariots by themselves with metal hooks buried into their backs.”

“Or the Shias. Whipping themselves to mush.”

The dark man tensed into a crouch and sprung to a jutting brick above. He couldn’t grab on. As he fell through the air he hammered the wall with his fingertips, striking like a snake at its surface. On the fourth attempt the fingers stuck. His shoulder wrenched and his body twisted but he clung on with a soft, stifled cry. We exhaled as one. He swung like a pendulum from one hand, grinning down at us unflustered, until he found a niche for his other. Extending his legs, he swung them up over his head so now he was upside down, biceps bursting, lank hair falling in perfect glistening straights like granite rain. He took a foothold and pulled himself upright. Relief in the cheering now.

When I dream about Leila she is always in the distance, outside the light, but I know she has a warm, open face.

I still see her eyes, light like my mother’s, irises warm gold-brown pools in which the sun set ablaze radial chips of malachite, green and faintly black. She is impatient to meet the world, my little girl grown. She is taller than me. This makes me so happy. Sometimes she’s in school uniform, walking toe-heel, toe-heel, back arched, the proud shoulders and strong nose of all the women in our family.

Today she turned nineteen. Desires, insecurities, angers that I know nothing of, though I must’ve played my part in. I would know so little about her now. Maybe her laugh. When she was an infant I’d bring my face right to her nose and make a funny sound – “khwaaishhh” – and she’d squirm with delight, cackling with a deep, cadent lilt. Her laughter now will carry a kernel of that. So I come to Purity One on her birthday. To ask her for forgiveness. We didn’t respect these walls, so they took her from me. Sixteen years. Does she wonder sometimes where I am? If I abandoned her? I’ve read the books. She won’t remember. She was taken on her birthday, only three years old, so she doesn’t, can’t, remember. When I think about this, it’s like I’m burning on the inside. She wouldn’t know me if we crossed on the road.

To her I am an emptiness, an ache she cannot understand but yearns to fill.

No. I have left more, a glimmer at least. The blurred outline of a face. A tracery of scent. The weight of fingertips on her cheek. The warmth of her first cradle, my arms. I found a journal on early cognition in the library. One article said our first memories go back to two and a few months. We don’t remember how things flow into each other, how they are linked, but our minds can place, in the vast fog, discrete islands. Maybe she remembers accompanying me to the mall one winter morning, white-frame sunglasses on her head. A Santa greeting the customers walking in. Leila so thrilled by this her shoulders began to vibrate. She squeezed my hand, still trembling, tugging gently until we stepped out of the security-check line.

I could only see his unfitness. Thin-limbed, dark-skinned, sweating in the hard noon sun. Over the double doors forlorn clumps of cotton glued to the lintel. Peach foundation trickling down his forehead like muddy rain down a window. But Leila was transported. She ran to him, mindless of the stale, cheap duvetyne, its acrid whiff. She was laughing and he pinched her cheek between his hairy knuckles. I didn’t say a word.

“You want a present from Santa?” I finally asked. There were gift-wrapped boxes piled against the front window, clearly empty.

Leila looked confused by this. Maybe she didn’t know what Santa did. The suit, the beard, an image in some book come to life, this was what thrilled her. The burden of age is expectation. It leaves a judging eye. She turned to me and smiled in a lopsided way, as if suddenly aware of her excitement, and when I saw her expression, that gentle smirk, I felt her elation as if it were growing within me. Of course this place was enough. There was charm to be found here, there was nothing tacky. My baby’s full-beam happiness at its centre, and I as innocent as her, as untroubled.

All this. Why do I fool myself? Leila will remember something quite different, if she remembers anything at all.

Excerpted with permission from Leila, Prayaag Akbar, Simon & Schuster.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.