Across the border

Celebrating life in a graveyard: For Hazaras in Quetta, a cemetery doubles up as a community centre

For the persecuted community, a burial ground serves as everything from a playground to a marketplace for the Hazaras in this Pakistani city.

“Are you Chinese?” I have been asked many times, owing to my physical appearance.

On hearing “no”, they would ask me: “You must be from Hunza, then?”

“No, I am from Quetta,” I would answer.

Their next guess would instantly be: “Then obviously you are a Pathan…”

“No, I am a Hazara.”

“Oh! So you are one of the people who are being persecuted.”

Persecuted. It is so painful to hear this every time I introduce myself. My friends, too, face the same situation when meeting someone new.

Incidents such as the one a few days ago in which members of a Hazara family travelling to Quetta from Chaman were fired upon, killing four of them, including a 12-year-old boy, have become part and parcel of what it is to belong to our community.

Be that as it may, the Hazaras, a long-oppressed and marginalised people, are also a very resilient one. Despite living with a sword hanging above our heads, we choose to look past the blood and bullets and attempt to have (with some strange measure of success) a semblance of a normal life.

Thus, I was driven to tell the story of my people and my surroundings. For that I launched a project called Humara Mohallah, which shows different neighbourhoods in Pakistan in interesting and relatable ways through visual storytelling.

Recreation in a graveyard

One such story, titled What We Leave Behind, is an attempt to show the Hazara community in Quetta persevering in the face of the inequities they face. It showcases the people who have been ravaged by the ongoing terrorism for nearly two decades.

The wanton persecution has prevented them not only from promoting their culture, but also severely hampered their participation in civic and public life.

The community is confined to a handful areas of the city: Alamdar Road and Hazara Town. It is a prison in the guise of a sanctuary.

Play

The video features a graveyard, filled with the bodies of the people who have died in terrorist attacks and targeted killings over the years. The story, however, is not just about the graveyard.

It tells much more – about a people who have repurposed the graveyard into a community centre, making it an integral part of their daily lives. A place of reflection, recreation, and ultimate destination, if you will.

A unique and beautiful graveyard where everyone’s loved ones are buried is the same place where a great many memorable moments are spent.

Having always been symbolised as a place of fear and unease, the word graveyard typically brings an almost irrational terror to one’s heart.

However, defying all conventional definitions of a cemetery stands Quetta’s Hazara graveyard: the Bihisht-e-Zainab.

Here, happiness begins from being amongst the dead. The locals celebrate Eid by going to the graveyard and remembering the loved ones they have lost – some souls lost to age, some to illness, while others ripped away at the end of a barrel.

Due to the lack of parks – or any other place to hang out – each day begins with a group of men and women making their morning rounds in the graveyard premises.

As the sun rises, the rejuvenating light chases away the dark insecurities of the night, and life begins anew, the deafening song of birds shattering the stillness of the cemetery.

When the clock strikes 10, the vegetable market located within the graveyard gets filled with women and one can hear the pleasurable sounds of their bangles jingling complemented with the sweet, chirping of their voices.

Along with these women, children can also be seen playing and their elated shrieks fill the atmosphere with a sense of community. A sense of belonging. An illusion of peace.

Marketplace in the graveyard. All photos by author
Marketplace in the graveyard. All photos by author

One day I met an old man passing by on a street in the graveyard. I found myself compelled to strike a conversation with him. I asked the man where he was off to, to which he replied, “I’ve brought my grandson for an outing so his mother can perform her household chores in peace.” The child was gleefully absorbing the sights and sounds from his pram, feeling at home in the resting place of his forefathers.

Just a few paces away from there, some old men sit languidly under the tranquil shade of trees every day, and reminisce about their fascinating past, no doubt one-upping each other, trading barbs or just sharing stories of happiness and heartaches.

An old man out with his grandson for some fresh air.
An old man out with his grandson for some fresh air.

The evening brings with it the most important activity of the day. The stones that are used to mark the graves are given a decidedly less morbid purpose. They are used as an accessory in the game of Sang Girag which the Hazaras have been playing for centuries.

In the game, two teams of three to five players hold smooth round stones – typically the size of a cricket ball – and turn by turn, hurl them at a cylindrical target called a qarqa. Striking the qarqa gets you a point. The team that is the first to reach 10 points is declared the winner.

A man throwing a stone at the qarqa in the game known as Sang Girag. People of all ages gather to watch the game of Sang Girag.
A man throwing a stone at the qarqa in the game known as Sang Girag. People of all ages gather to watch the game of Sang Girag.

People of all ages partake in the action, even octogenarians. Others sit and watch, cheering for the ones they support and laughing at every misstep, many holding prayer beads in their hands.

People of all ages gather to watch the game of Sang Girag.
People of all ages gather to watch the game of Sang Girag.

As night falls, like clockwork, the people make their way back through the pathways of the graveyard that branch off to their respective homes, only to return the next morning to add soul to what would have otherwise been a place devoid of life.

One might wonder why a cemetery has been chosen for the purpose of community building. Due to the widespread fear of being attacked, the people largely do not leave their homes and instead find comfort in a place nearby.

The mountains surrounding our homes act as natural sentries, keeping us safe.
The mountains surrounding our homes act as natural sentries, keeping us safe.

The graveyard offers the distinct advantage of providing a safe space for people to gather as it is guarded by mountains on three sides and the streets all lead straight to their homes.

Though craggy stone, the dry, gray behemoths are perpetual sentries, proving to be effective protection for a people who have been forced to rely on inanimate objects and natural escape routes for their safety.

More than a century old, the graveyard, which once saw only a handful of visitors, now sees an entire community making full use of the only escape they have and, ironically, celebrating their lives among the dead, defiant in the face of systematic ethnic and sectarian attacks and hatred.

As narrated to Sameen Daud Khan, who put it together in the form of a blog.

This article first appeared on Dawn.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

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