Why the fate of Tibetan refugees in Arunachal Pradesh should not depend on India’s ties with China

The state is set to implement the 2014 Tibetan Rehabilitation Policy, but it may not be nearly enough.

Who is a refugee and who is an illegal immigrant? It is a potent question in a country without a refugee policy. Under existing laws regulating the flow of foreigners into India, any non-citizen who enters without a travel document is an illegal immigrant. Such laws are blind to refugees or asylum seekers fleeing war, genocide or economic distress.

The Indian government made an exception for Tibetans who flooded into the country after China invaded Tibet in 1959. They were recognised as refugees and automatically granted registration certificates. According to the Tibetan government-in-exile in Dharamshala, the certificates allowed them “the right to enjoy all the privileges enjoyed by any Indian citizen except the right to vote and work in Indian government offices”.

Researchers have questioned the extent of these “privileges”. Reports point out that, without citizenship, many Tibetans faced restrictions on travel, on access to government jobs, and on owning land. In some states, they cannot get driving licences or bank loans. In sectors where they can work, they often face discrimination from Indian employers. Besides, even registration certificates have become harder to get over the years.

But with the Tibetan Rehabilitation Policy, introduced by the central government in 2014, a few “privileges” might materialise. The policy contains provisions to lease land, and makes Tibetan refugees eligible for public welfare schemes, to pursue any jobs they are qualified for, and to acquire licences for a range of economic activity. The Central Tibetan Administration called it an important document, as the Centre had previously neglected to institute a uniform policy across various states.

Such a policy must be welcomed; greater rights for any deprived, stateless population can only be a step in the right direction. But in Arunachal Pradesh, located on the edge of Tibet and coveted by China, it is fraught with other political factors. Three years after the policy was floated by the Centre, Arunachal Pradesh is set to implement it. It is a decision buffeted by the internal politics of a protected state as well as New Delhi’s larger geopolitical calculations.

Protected state

When China invaded Tibet in 1959, a flood of refugees poured in through the North East Frontier Agency (present-day Arunachal). Three years later, when the Chinese invaded the North East Frontier Agency, they fled further inland. Many local residents fled with them. Afterwards, most of the local inhabitants returned. As for the Tibetan refugees, most of them spread out in settlements across the country, although some came back.

In the decades since then, those who had once fled together became distinct as foreigners and indigenous inhabitants. The Tibetans stayed on in three separate settlements, without being recognised as Indian citizens. The North East Frontier Agency became Arunachal Pradesh, a state built around indigenous identities, fiercely guarding the special protections guaranteed to it under 19th century laws. Agitating Arunachali groups now argue that the policy for Tibetan refugees would disrupt these protections.

Arunachal is cordoned off by the Inner Line Permit, a system to regulate the entry of outsiders that flows from the Bengal Eastern Frontier Regulation of 1873. In 1896, the Chin Hills Regulations were introduced, empowering the district administration to expel undesirable outsiders. With Independence, the line of isolation was reimagined as the line of protection, meant to safeguard “indigenous” tribal cultures, and shaped politics in most states of the North East.

These laws were cited as Arunachali groups marched against the Chakma refugees who poured into the state, mostly from the Chittagong Hill Tracts in Bangladesh. After 2015, when the Supreme Court directed the Centre to provide citizenship rights for 7,000 Chakma refugees who had settled in the state between 1964 and 1969, the agitations gained momentum. These laws are being cited again against the Tibetan Rehabilitation Policy.

In response, the Bharatiya Janata Party, which formed a government in Arunachal last year, said the policy would not affect indigenous groups. Unlike the Chakmas, Tibetans would not get citizenship, only certain benefits. The state leadership must now balance the competing demands of indigenous identity politics and rights for certain refugees, dictated by politics at the Centre. Citizenship rights for the Chakmas got absorbed into the BJP’s project to accommodate non-Muslim minorities from neighbouring countries. Meanwhile, rehabilitation for Tibetan refugees in Arunachal comes after a new low in relations with China.

Sparring with China

Researchers point out that the “privileges” granted to Tibetan refugees in India have fluctuated with the highs and lows of India-China relations. The refugees who fled with the Dalai Lama in 1959 were given land and housing by the Jawaharlal Nehru government, which negotiated a tricky course with China.

But after 1963, as India began recovering from a border conflict with China, New Delhi stopped legally recognising fleeing Tibetans as refugees. Soon, registration certificates were no longer granted automatically and Tibetans in India lost the right to own land. After 1970, newly arrived Tibetans had to make do with a shrinking pool of rights and services, possibly an effort to preserve Indo-Chinese relations. In 1976, the two countries resumed diplomatic relations after 15 years. As India strove to stabilise ties with Beijing, it frowned upon political demonstrations by Tibetans. When Chinese heads of state visited in 1991 and 2011, Tibetan refugee leaders were arrested and placed under surveillance.

However, ever since the Chinese army made incursions into Depsang, Ladakh, in April 2013, brittleness has returned to ties between the two countries. Prime Minister Narendra Modi and President Xi Jinping have had several high profile meetings. But even as Modi and Xi shared a swing in Ahmedabad, the two armies were engaged in border skirmishes. This year, storm clouds gathered over the One Belt One Road initiative and the China Pakistan Economic Corridor, both projects marshalled by Beijing and regarded coldly by Delhi. Matters came to a head with the Doklam border stand-off.

Arunachal and Tibet have been running motifs in these hostilities. When the Dalai Lama visited Arunachal earlier this year, Beijing objected. As India refused to back down, it retaliated by renaming six districts in Arunachal, which it calls “South Tibet” and claims as its own. In July, External Affairs Minister Sushma Swaraj said there could be no “quid pro quo” on two issues: China issuing stapled visas for inhabitants of Arunachal and India talking about the sufferings of the Tibetan people.

Politics and the refugee

Given the history of Tibetan refugees in India, the new rehabilitation policy cannot be isolated from these events. Privileges granted in such a climate could be dangerously unstable, especially since India has refrained from making international legal commitments, such as signing the 1951 United Nations Refugee Convention.

In the absence of national laws and international or regional obligations, India can tweak its stance on various refugee groups according to its political needs. Even as it shows greater warmth towards Tibetan refugees, for instance, New Delhi prepares to deport thousands of Rohingyas who have fled massacres in Myanmar. Modi will stop at Myanmar on his way back from the BRICS Summit in China next week. But since New Delhi is competing with China for Myanmar’s affections, observers find it unlikely that the prime minister will raise the matter of the alleged genocide of the Rohingya by the Myanmar army or lend a sympathetic ear to the refugees it has created.

The fate of thousands of Tibetans and Rohingyas should not be dependent on India’s strategic and political interests, or on domestic state politics. Yet, unfortunately, these appear be the main factors determining who may be called a refugee and who an illegal immigrant in India.

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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.

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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.

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Getting the best from collaborations

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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 Scroll.in marketing team and not by the Scroll.in editorial staff.