The BJP’s denial of refugee status to Rohingyas is in line with the (flawed) logic of Partition

The refugee policies of India and Bangladesh continue to be dictated by the events of 1947.

The Narendra Modi government’s denial of refuge to Rohingyas fleeing persecution in Myanmar is seen as a choice made between humanitarianism and security from Islamic terrorism. Somewhere amid these rhetorical flushes rests the (flawed) logic of Independence and Partition that determined the refugee policies of India and Bangladesh, which in 1947 was separated from India to form the region called East Pakistan. History suggests that the Modi government’s policy is very much in continuity with those of the previous regimes in India.

The birth of the Republic of India was accompanied by violent and massive demographic exchange in the wake of Partition, probably the biggest refugee crisis in history. Compared to the rest of India, the demographic exchange in the wake of the Partition was near-total in Punjab, and significant in Bengal, respectively. Once Pakistan was carved out as the homeland of Muslims of these two partitioned states, and displaced Muslims went to East and West Pakistan, it was foundational for India to grant refuge to Hindus and Sikh members of ethnic communities such as Punjabis or Bengalis from Pakistan.

The scale of Partition violence, and its subsequent memory, ruled out any acceptance of Bengali and Punjabi-speaking Muslims as refugees. These were supposed to be the responsibility of Pakistan (including East Pakistan, now Bangladesh). To a lesser degree, this was true for other parts of North and Central India as well.

However, in a big country such as India, there are states such as Tamil Nadu and Assam where a composite sense of regional identity has dominated political culture. The Partition did not have such an impact in these states. Consequently, an ethnic Bengali Muslim from Myanmar (Rohingya) cannot seek refuge in India, but a Tamil Muslim from Sri Lanka can. In fact, many of them have, when they sought to escape the tumultuous civil war years in Sri Lanka.

Offering shelter

After Independence, citizenship was granted by the Indian government to all those who were born and living in the country prior to the adoption of the Constitution in 1949-’50. This included a sizeable number of Muslims in India, just as it included a sizeable number of Hindus and Buddhists in Pakistan (especially East Pakistan). An interesting trajectory in its own right, the non-acceptance of the logic of Partition by large groups of peoples and individuals, and its consequences, are a separate issue not dealt with here.

India has also been accepting Buddhist Tibetan refugees since the 1950s. It is tempting to say that realpolitik was a greater determinant behind the acceptance of Tibetan Buddhists than anything else. However, the colonial knowledge system that leaders of post-colonial rulers of India inherited saw Buddhism as India’s gift to the world. Jawaharlal Nehru always discussed the Buddha glowingly in his Discovery of India. BR Ambedkar also saw Buddhism, not Hinduism, as the authentic religion of India. Same goes for many other luminaries in the nationalist pantheon.

On the other hand, India has let Muslims of Afghan origins lead a life in Delhi, but has granted them Long Term Visas for stay, not refugee status. Even refugees of the predominantly Muslim Rohingya community community that are presently living in India do so on Long Term Visas, not as refugees.

The case of Assam

India made a very different choice in 1971, when huge numbers of largely Muslim, but also Hindu and Buddhist East Pakistanis (now Bangladeshis), started pouring into the country leading to the Third Indo-Pakistan War. Many of these migrants are yet to go back to Bangladesh, and their claims to citizenship or refugee status in India are a vexed issue. These are points of serious political contention in Assam, Arunachal Pradesh, Meghalaya and elsewhere in Eastern and North-Eastern India.

The government of India chose to provide either citizenship, refuge or “illegal status” to resolve the influx from Bangladesh. It never offered refuge to any Muslim Bangladeshis (earlier East Pakistanis). Unlike Muslims from Bangladesh, Buddhist Chakmas from Bangladesh were provided refuge in India. Just to reaffirm this point, in 2015, the Supreme Court ordered the state of Arunachal Pradesh to ensure that all Buddhist Chakma refugees are granted citizenship and treated at par with other Indians. This went against local sentiment in Arunachal Pradesh and all of North-East India that sees all Bangladeshi settlers, irrespective of their legal status, with disdain.

By seeking to provide refugee status to Hindu Bangladeshis, against local sentiment in the North-East, the Modi Government is not doing anything new. Its active rhetoric of providing refuge to Hindus, Buddhists and Sikhs from East and West Pakistan may or may not match the ground reality, but its policies are built and extended upon the legacy of Nehru and the foundational logic of 1947.

Question of self-identification

It is very important to point out that in some cases, the logic of 1947 has also led to Muslim refugees (Tamil Muslims from Sri Lanka) being admitted to India, and Hindus not being granted refuge in India. The refusal of the Government of India to grant refugee status to even one out of lakhs of ethnic Nepalese people kicked out of Bhutan as “illegal” settlers during an ethnic cleansing in the 1980s and 1990s might seem striking. Even more so because these were Hindus without a home.

However, in this case, the self-identification of these people was more as Nepalese than Hindus. While, some of them have been accepted by Nepal as refugees, most have been granted refuge not by Nepal or India, but by the United States, and to a lesser extent by smaller First World countries. Unlike Tamils, whose homeland exists in India, the homeland of Nepalese people exists outside India. Thus, in cases where a regional identity or pan-South Asian identity is involved, the Hindu-Muslim lens of looking at people breaks down.

The Modi government should not be seen as novel in refusing to come to the aid of Muslim Rohingyas. The logic and patterns of nationhood determined in the formative years around 1947 (and 1971) continue to determine the trajectory of nationhood and refugee policies of India and all other South Asian states. Here, humanitarian concerns stand on a pedestal lower than ideas of nationhood. As per the logic of 1947, foundational to the birth and subsequent evolution of India, Pakistan and Bangladesh, the Rohingyas, whose language is akin to the Chittagong dialect of Bangla, fall into the care of Bangladesh. Bangladesh, too, in its self-image as the nation of Bengali Muslims, has provided refuge to the Rohingyas.

Vikas Rathee is Assistant Professor in History, Central University of Punjab.

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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.

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.