Openness and participation, or transparency and inclusion, to use more fancy synonyms are key concepts in any society, which wants to see peaceful and democratic development. We never get enough of it!
At the same time, not everything should be discussed in big and principled ways in public. Sometimes, it can be better not to draw conclusions, but let debates shed light on issues without judging what is right and wrong, and acknowledging that there may be more than one solution, more than one way. In this article, I shall discuss some examples where greater openness and participation would not only be positive, but would also lead to less suffering of many people.
Recently, we have seen terrible media reports from Balochistan. We have known about the internal strife, with abductions and killings in the province. It did not begin yesterday, or during President Pervez Musharraf’s time, but it did become harder by the heavy-handed military approach and it has escalated. Obviously, there are many historical and other internal and external reasons for the sad state of affairs. In many ways, Balochistan’s problems are arch-typical of underdevelopment, especially when the natural resources are in abundance. Typical for the situation is that there has been lack of openness and participation by ordinary people. The owners of the land and mines, the foreign companies, the civil servants and politicians, and others high-up have benefited. Had there been more openness and participation, the possibilities for corruption would have been much less. The people would have benefited from the resources in the province.
I do not need to go into detail as for how shocking it was to learn about the feather-light, starved and mistreated prisoners and detainees, who came out barely alive, hardly able to walk on their own. It reminded us of how prisoners were treated during World War II. What a shame it is for Pakistan that this could happen in peace time. Yet, it could have happened in most countries in the world, and it can happen again if there is lack of openness and participation.
We have seen many outrageous abuse cases from Iraq and Afghanistan prisons, happening at the watch of American and Nato commanders, from whom we expect more. Usually, the excuse is that those in charge were “a few bad apples”, but, in actual fact, they are usually condoned, institutionalised and structural situations.
It remains a fact that most institutions, organisations and groups that operate “behind the veil”, sooner or later, misuse power and go astray - from abuse in the home, in kindergarten and school, and in neighbourhood and local community, because people don’t know or, they choose not to know and not to see. We can go further, institutions such as prisons, military barracks, hospitals and psychiatric wards, care homes, and so on, usually operate in “cultures of abuse”. Such institutions operate without proper control from the users and the public. They may have professional control systems and ethical regulatory bodies, and that helps, but still there is a need for the general public and laymen to know what happens. The media can play a major role in sounding the alarm when something is wrong.
In my home country, Norway, we have also had cases of abuse and misuse of power. In a small, wealthy and very well-organised country, like Norway, I always feel very sad when cases are discovered, and I always wonder why it took so long before they came to the knowledge of the public and were stopped. Let me take the psychiatric care sector, which we in the early 1990s changed from hospital care to community care as the key concept. The “HVPU Reform”, an acronym from Norwegian, meant the closing of most mental hospitals and wards for long-term patients and a change to more and better care in the local communities, with a combination of medical and professional support, on the one hand, and common inclusion in society, on the other. It turned out to be better care for most patients, or part-time patients, and it also became better for families and friends. Only severely ill patients, mainly being very violent and a risk to themselves and the community would remain in a hospital or another institution. The specialised hospitals also receive patients, who needed short-term care. Why did we get the reform the time we did in Norway and, little by little, in the West in general? A major reason was the discovery of abuse and professional neglect, with a number of scandals shedding light on the general situation. The politicians, but often not the majority of the professionals, wanted change, openness and participation from the patients themselves, their families and the local community at large.
I will not even begin exploring the situation of the mentally ill in Pakistan and other developing countries. Due to limited economic resources, too few professionals and lack of general understanding for the mentally ill, very limited treatment is given. Families, who have mentally ill children and adults (and most do), often hide them and let them be bedridden when they could have lived more active and quite normal lives. In hospitals, patients are often doped to keep them quiet, and if they are violent, often due to frustration, they may be chained to their beds.
It should be added that there are many causes of mental illness, including drug and alcohol abuse, and natural reactions to wars, conflicts and disasters. When I earlier worked with Afghan refugees, we estimated that some 25 percent needed professional treatment and medication, but very few would receive it. Many were treated badly even openly. We could only fear how they would be treated when nobody could see.
Let me hasten to say that Pakistanis and Afghans are not bad people. As a matter of fact, they are good and friendly people, often more patient and better than a Westerner like myself. But again, there is lack of openness and participation. And there is lack professional knowledge and general understanding.
This leads me to discuss some aspects of how people we define as sick should be treated, and other people we place in institutions, such as prisons, children’s homes and old people’s homes. The sad fact is that when we human beings place people in institutions, and they have little or no say over the way they are treated, abuse will happen, more as rule than an exception.
Furthermore, we also get blind to what we choose to see as abuse. For example, we will rationalise why a mentally ill and violent person, who remains chained to his bed in a shed in the mountains, away from human company, has to be treated that way. We will rationalise and find explanations (read: excuses) for why this is the best we can do for him.
In this article, I emphasise that ‘openness’ is the remedy for better treatment of people in institutions where the doors generally remain locked. But I also underline ‘participation’. People in the institutions must participate themselves, with relatives and others, and with professionals. As often as possible, institutions should be ‘open institutions’, not closed and hidden from society. They should be ‘polyclinics’.
The society and its members must educate itself about what fair treatment is of people living in institutions, and others living “behind the veil”. If human rights are universal, then they should include all persons, even if they live in institutions and are looked after by others. Subgroups, too, such as prostitutes, must also be treated humanely. A society’s attitudes and values are clearly seen as regards the way women and children are treated. Often, women have no income of their own, yet, in rural settings they contribute to the family’s livelihood as much as the men, sometimes even more. But their rights are de facto often limited - and we accept it! We accept what we actually consider to be wrong!
Last week, I came across some statistics about pregnant women being sacked from their jobs. They would need a few months before and after delivery. In other cases, it was said that young women, who planned to raise children not be employed. No, this was not in Pakistan; this was in America, one of the most liberal and modern countries, which in many other ways have reached far.
This example shows that people can accept what is unfair, even when everybody sees it. We will start explaining, rationalising and excusing it. Hence, openness is not enough. There must also be participation. Those concerned must be part of setting the standards and controlling the systems. We need the professionals to help us define what the optimal conditions are, and we need the social scientists to place it all in a broader and holistic context - as we move towards more democratic and humane societies for all.
The writer is a senior Norwegian social scientist based in Islamabad. He has served as United Nations specialist in the United States, as well as various countries in Africa and Asia. He has also spent a decade dealing with the Afghan refugee crisis and university education in Pakistan.
Email: atlehetland@yahoo.com