The trinity of transparency, accountability and efficiency are also at play in the world of public health. In the book Governing Global Health by Chelsea Clinton and Devi Sridhar, that I am reading now, this theme comes up time and again. They both argue that among the various organizations that they have studied in the book, including World Health Organization, Gates Foundation; WHO comes up short on transparency measures.
They point out that WHO does not have a transparency policy and also does not report to the International Aid Transparency Initiative (IATI). They do point out to the presence of some measures such as livestreaming of Executive Board meetings as example of some transparency. While no one today would question the need for transparency, the question is how can people use it? But does having more transparency really make all the difference? The assumption behind calling for more transparency is that it will enhance participation, questioning from all stakeholders and make the process more equitable. But what of the converse situation, where there may be more procedural transparency, but no substantive transparency; in that there is no actual recourse to using this information to correcting the perceived wrongs? This is an aspect that hasn’t been discussed in much depth.
Their recommendation is for the older institutions such as the WHO and World Bank to increase their stakeholder engagement and transparency to ‘regain their legitimacy and public trust.’ (p.160).
I am writing this on the second day of election results, that have shaken the country; rather badly. With the election of Donald Trump, Washington D.C., is in mourning. It looks and feels like almost all of the country is at the precipice of something. Mainstream media are still coming to terms with what this means. While the pundits speculate and those who have won celebrate, the question that seems to be at the back of everyone’s mind – and this is a very serious one – is whether the U.S. will stop being a ‘land of opportunities.’ By this, most people mean an inclusive society, where everyone stands a fair chance of succeeding, despite one’s origins, social status or religious beliefs.
At first glance, it looks like everything that the progressives fought for is at stake. There is enough empirical proof for this fear. Consider this : In his memo, Mr. Trump has indicated that he will scrap all ‘unconstitutional Executive Orders’ of President Obama in his first 100 days. In addition, he has also indicated that he will ‘remove criminal illegal immigrants’ and ‘suspend immigration from terror prone regions’ meaning putting an end to the refugee resettlement plans. Also, significantly, he has promised to cancel payments to the UN Climate Change plans.
While each of these will impact an area of American public life, what is at stake is ultimately how Americans define who they are and the ‘myths’ that uphold their sense of identity. As Robert Wuthnow points out in his book American Mythos, the myths of American being a ‘land of opportunity’ that gives everyone a fair chance is true only because a lot of people ( if not all) believe in it, and work to make it possible. If there is a seismic shift in this attitude, and there is great skepticism and nationalism – combined with isolationism – as we are seeing globally, with Brexit and the recent reaction in the US Elections, then this myth may well be no longer believed.
In this interview, Wuthnow offers an insight into materialism and immigration. Using the perspective of materialism among immigrants, he suggests that the sense of hardship and sacrifice were part of their narratives. These narratives helped shape their immigrant identity. There seems to be a clash of narratives taking place now. With the rise of a nativist narratives, that are defining America being only a place for caucasians? The blatant racism that was on play during the election seems to be playing out, with increased incidents of racist attacks, as several media are reporting – across the country.
The narratives of migration, opportunity and freedom have defined America. If these shift in a major way, then everything that the country stands for will also change. We are already witnessing isolationism, nativism and protectionism in Europe and other parts of the world. Is this a trend that will catch up in the U.S., as well?
While it is too early to say how the next four years will shape up and what it would mean, for immigrants and others; who see the U.S. as their home; one can see that the meta-narratives about what the U.S. is, and what it stands for, is changing.
While there is no need to panic, I do believe it is time for right-thinking people to reexamine how the current political scenario will impact all Americans – whether they are Republicans or Democrats.
There is certainly need for more dialogue, tolerance and open mindedness on part of everyone. But the ball is certainly in the Republicans court. Given that the administration is going to be run by Mr.Trump’s side, and much of the rhetoric that has caused division has come from that camp, it falls on them to reach out and heal the wounds. It falls upon Mr. Trump to also be Presidential and stand up for what makes America a great nation – tolerance, openness, inclusiveness and creativity. To ignore this and to remain silent while his supporters create fear and intolerance would be betraying the very values that made his success possible.
“When you arise in the morning, think of what a precious privilege it is to be alive – to breathe, to think, to enjoy, to live “ – Marcus Aurelius.
I want you to reflect on this positive, life-enforcing thought before I get into discussing death. Close your eyes for a minute and take the time to be thankful for your life. I am sure there are a few things that you are grateful for, no matter how miserable, poor, constricting your life is, or on the contrary how rich, full and abundant it is. No matter what, I believe we have to be thankful for one thing – the gift of life.
Having said that, I must admit that there is too much death in the air, this winter. Right from the shootings at Sandy Hook Elementary School a week ago, which claimed 26 innocent people in a school in Connecticut, to talks of the world ending (the infamous Mayan prophecy), there seems to be a lot of morbidity in the air. I am even noticing books on death. Not surprisingly, I walked into the library today, and noticed “Mortality,” a book based on the account of Christopher Hitchens’s last days of battle with Cancer, before he died. And less than a week ago, I received an email from dear friend, who I have known for a few years now. She was writing to say a final “goodbye” before dying. While it shocked me initially and kept me awake for two straight nights, I eventually made peace with her mortality (and partly, my own), to the extent that I could function normally. When I got my bearings right, I learnt more details of her illness and only now have I come to terms with the fact that though she is terminally ill, there are some things that I can do to help her, ease her suffering.
The media is also abuzz with follow-up stories of the kids who died at Sandy Hook and the reactions of various stake-holders to it. Social media is also active with anti-gun law talk, of how violence is becoming all pervasive and how NRA and its supporters simply don’t “get it”. On the other end of the spectrum are talks about how drones are killing hundreds of innocent children in Pakistan and it is the US which is the aggressor there and clearly no Americans are showing any remorse or regret at this. There is talk of hypocrisy and double-standards in measuring the value of lives, depending on where you are. Irrespective of this, talk of death and end of life is in the air.
Amidst all this, is the question of how one should talk of death, how our culture(s) honor death and what is ok when it comes to the process of dying itself ? How should people around a terminally ill/ dying person talk about death and what about instances of accidents/ homicides ? What are the norms of “death talk” and how can we dignify the dying person?
Dealing with death : The East-West divide ?
Christopher Hitchens in his short book “Mortality” talks about his last few months of life as he battles Cancer. This paragraph in the book is poignant, as it is powerful :” Allow me to inform you, though, that when you sit in a room with a set of other finalists, and kindly people bring in a huge transparent bag of poison and plug it into your arm, and you either read or don’t read a book while the venom sack gradually empties itself into your system, the image of the ardent soldier or revolutionary is the very last one that will occur to you. You feel swamped with passivity and impotence: dissolving in powerlessness like a sugar lump in water.”
There seem to be clear distinctions between how death is seen across the East, West divide. Sorry to be putting these two large buckets to classify such complex cultures across the world, but it may help to look at some distinctions, without making very broad generalizations.
One of my favorite Hadith (sayings of the Prophet Muhammad ) is :” “Conduct yourself in this world as if you are here to stay forever, and yet prepare for eternity as if you are to die tomorrow.” Islam, treats death as a natural occurrence and something which one must not be afraid of. It is to be faced with equanimity and stoicism. There are numerous Hadiths of the prophet extolling believers to pray for the deceased and also various customs and traditions, which involve visiting the grave yards before important festivals. Death is a fairly public affair and everyone is consciously aware of it, and partakes in the ceremonies.
While some cultures mourn the dead, others celebrate death, seeing it as a transitory phase, one which should be welcomed. I remember taking part in a “death ceremony” of sorts in Bali, Indonesia, when I visited the beautiful island way back in 2008. Held with great festivities and celebration, this marks the transition of the body and soul for the Balinese people and the entire village takes place in this ceremony. In fact, we, as tourists were invited to take part in these celebrations and I must admit it felt more like a happy festival, than a ceremony marking someone’s death.
It is not a private affair as in the western world. Infact just yesterday, I was chatting with a friend, on the way home. When she told me that her parents had passed away a few years ago and she was going to visit her brother over Christmas, I told her that I was sorry to hear that. In fact, she brought up the issue of death as something that her friends just didn’t talk about and it also amazed her that the culture that she had grown up (she is American) does not discuss, talk about death in a public way. It is considered a private realm and only the immediate family and friends are invited to participate in it.
That brings me to another interesting observation: It is more than five years since I have attended a funeral. Not a single one in the U.S and it is about the same time since I have attended or seen a new born. It seems like I have been cut off from life’s most defining moments. Living outside my home country has effectively deprived me of this connection to “real” life.
Pop-culture and death-talk in the west
I am reminded of The last lecture – by Prof. Randy Pausch, a professor at Carnegie Mellon University, who died of Pancreatic Cancer a few years, made famous with his “The Last Lecture” and the book of the same name, also advocated for research on Pancreatic cancer. While for some this comes across as too sugar-coated, and Hitchens mentions this in his book, saying:” Pausch’s video has so much sugar, that it may go with a warning: you may need a shot of insulin to withstand it”. But between his cynicism and Paushch’s over-optimism, there is a middle ground. And that is provided in a sobering note by none other than Steve Jobs, Apple’s iconic founder.
Steve Jobs spoke of death at Stanford University Commencement ceremony in 2005, where he poignantly said:” Remembering that I will be dead soon has helped me make the big choices. All external expectations, pride – fall away in the face of death. Knowing you are going to die soon is the best way to get out of the trap that you have something to lose. You are already naked. There is no reason not to follow your heart”.
From what I have seen so far, death-talk in the west does not happen too often, and even if it does, it is terms of a consolation or perhaps at best trying to frame the talk around some religious construct. Death somehow is brushed under the carpet, and not dealt with in the same manner that Jobs advocated.
What to do when someone is dying?
While I have no substantial experience helping people who are dying, I do have some “common-sense” notions of what to do when you learn when someone is dying. No matter what, or who it is, the thing NOT to do is to ignore the news, or deny the person the opportunity to talk about it. That is clearly the most inhuman and ignorant thing to do. But from what I have heard, some people tend to do the same. They ignore the news or the person altogether, because it is “too much to handle”. I have two stories related to such behavior.
It may perhaps even help to find out one can help, not necessarily financially but also in terms of simple tasks or other ways to help the person deal with life and its complexities, while one is still alive.
Speaking of being in-discreet, Hitchens mentions an incident when a woman walked up to him at a book-store and informed that her cousin had died of cancer, and it was an excruciating and lonely death also because he had been homosexual and his family had disowned him. Clearly, not an inspiring or positive story and not certainly something you would tell a man who has cancer. He adds :” This was a surprisingly exhausting encounter, without which I could easily have done. It made me wonder if perhaps if there was room for a short hand book of cancer etiquette.” Perhaps there is and may be he should have written one, considering how indiscreet some people can be.
To sum up, I will borrow Jobs’ words, when he said :” Death is the best change agent and perhaps the best invention. It clears the way for the new, right now the new is you. Your time is limited, so don’t live others lives.”