A growing number of South Korean women are training to be morticians, a field from which they had long been excluded, amid changing views on gender roles and a rising preference for women’s bodies to be handled by women.
With recent deaths of female celebrities and prominent figures, as well as growing scrutiny of sex crimes against women, gender sensitivity is changing the way families of the deceased bid farewell to their grandmothers, mothers and daughters.
“I felt uncomfortable when my classmates of a different sex touched my body, even when I was fully dressed,” said Park Se-jung, 19, who is in her second year of funeral directing studies. “I sure wouldn’t want them to touch, wash and dress my naked body even if I were dead. I am determined I should be the one bidding those women a proper farewell.”
The trend comes amid growing calls for crackdowns of sexual violence against women, including a rash of hidden-camera crimes, “revenge porn”, and online networks that blackmailed women and girls into sharing sexual and sometimes violent images of themselves.
In the early 2000s, about a third of mortician students in the country were women, but today they make up around 60% of the class, said Lee Jong-woo, a professor of embalming at Eulji University in Seongnam near Seoul.
“With Confucian ideology, death was considered a taboo in South Korea in the past, and had negative perceptions of whether women could handle such work, but the perception has been changing,” Lee said.
Funeral companies say they have been receiving more requests for female morticians.
“Most of the deaths of young people are suicides, and the families of the bereaved, especially if it was suicide and a woman, feel more comfortable if we handle the body,” said Park Bo-ram, a funeral director of seven years.
“I recall a teenaged student, an only child … had committed suicide,” Park said. “Washing and dressing the body, I saw many signs of self-injury on her thigh, but none of her family knew.”
Park recalls that the girl’s parents were immensely grateful, even in the midst of sadness, that a female mortician handled their daughter’s body.
South Korea’s suicide rate is the highest in the developed world: 24.6 deaths per 100,000 people in 2019, compared with an OECD average of 11.3. That year, it was the No. 1 cause of death among teenagers and people in their 20s and 30s.
More than 4,000 women committed suicide in 2019, including young female K-pop artists Koo Hara and Sulli.
In 2016, a quarter of the country’s 6,200 funeral directors were women, and with more than 130,000 girls and women dying each year, requests for female funeral directors are expected to rise further, Korea Employment Information Service said.
Yet some resistance to women in the mortuary business remains.
Shin Hwa-jin, 21, who plans to work at a funeral home after graduation, said she was shocked to hear a female mortician relate a conversation with her mother-in-law.
“Her mother-in-law asked her: ‘How dare you think of cooking my meals with the hands that touched a dead body?’” she said.
Demonstrating grief through wailing and song has long been a historic, sacred part of honouring and remembering the dead. From the Chinese to the Assyrians, Irish and Ancient Greeks, oral rituals of outward mourning were a responsibility that fell (and continue to fall) to women.
In Ancient Greece, while women may have lacked political and social freedom, the realm of mourning belonged to them. Their role in remembering the dead granted them their only position of power in a society where they possessed no autonomy. Yet this power was also believed to supersede mortal constraints, giving women the ability to do something that men could not.
The Greek funeral was composed of three parts: the prothesis, or preparation and laying out of the body; the ekphora, or transportation to the place of burial; and the burial of the body or the entombment of cremated remains. It was during the prothesis that the women began their ritual of lament. First, they cleansed the corpse, anointed it and decorated it with aromatic garlands as it lay atop its kline (bier). Once the body was prepared, scores of female relatives gathered around it to beat their breasts and tear the hair from their scalps as they sang funeral songs. They wished to communicate the awful weight of their grief in order to satisfy the dead, whom they believed could hear and judge their cries. In contrast, the men kept their distance to salute the dead, physically signifying their separation from the realm that belonged to women. Some art from the Geometric period suggests they may have joined the female mourners in writhing to the lament, though they were spared from the excruciating gesture of ripping out their hair.
The funeral song served as an extension of the physical pain women inflicted upon themselves during the prothesis. Its purpose was to communicate a cry of uncontrollable pain, a hysteric melody that was believed to be rooted in feminine emotions; thus, only women could be the vessels for this pain. In the depths of their sorrow and self-torture, female mourners in the Geometric period would have sung a melody from one of the four major funeral song categories: threnos, epikedeion, ialemos or goos. These songs were personal and meaningful to the bereaved. In her book Aspects of Death in Early Greek Art and Poetry (1979), which, through the art they have left behind, analyses how the Ancient Greeks viewed death, Emily Vermeule writes that goos was the most intense kind of funeral song. It might have been reserved for lovers or close family members, as its theme was centred on the relationship between two lives shared, the one now lost.
Leading the funeral lament was the song leader, also called the eksarkhos gooio, or the chief mourner. In early times, she was a professional mourner, but could also be the mother or close female relative of the dead. The song leader served as the liaison between those who mourned and those who had passed, guiding the bereaved through the proper course of remembrance in order to mollify the dead. As she led the female mourners in lament, she was careful to cradle the head of the corpse. Touch was necessary in order to open the ears of the dead. But once the ears were opened, the living women had to tread carefully. Not only could the dead hear funeral laments sung for them during the prothesis, they could also determine whether the presence of the living was good or malevolent. This is the reason, writes Robert Garland in The Greek Way of Death (1985), that Odysseus is advised against participating in Ajax’s funeral. Mourners entrusted their song leader with the responsibility of appeasing the dead to ensure their smooth transition into the spirit world.
As time went on, the role of female song leader would serve as the predecessor to an occult offshoot, the goes, who used song as a vehicle to transcend mortal constraints. Under the goes, funeral songs were no longer songs: they were spells, used to lure the dead back to earth. The goes was akin to a witch, due to her supernatural powers; she had even mastered the art of necromancy and could temporarily bring corpses back to life. Yet, even before the goes and the eksarkhos gooio, women in Ancient Greece had ties to the occult side of death. If the eksarkhos gooio was the mother of this occult tradition and the goes the maiden, the egkhystristriai was the crone. Before the classical period, the egkhystristriai was believed to have officiated at the burial of the body. Like an occult high priestess, her powers stemmed from the ritual of making blood sacrifices to the dead. Later, these sacrifices turned into the more modest ritual of offering libations, exemplified as Antigone pours offerings over her brother Polyneikes after she performs rites over his body.
By the fifth century BC mourning rituals had become less elaborate and deliberately reduced the importance of the female role. The number of female lamenters who surrounded the dead dwindled from scores of close relatives to only a few. Laments became more antiphonal and grew to involve men. Gestures such as tearing the hair were replaced by the symbolic gesture of cutting the hair short. These later changes suggest that the Greeks believed their dead were in less need of appeasement, eradicating the need for a song leader with supernatural inclinations. But they attempted to diminish the role that women had in the death process, thus dismantling a space in which women held dominance. In the classical period, women were relegated to the background of the funerary ritual, writes Maria Serena Mirto in Death in the Greek World (2012), because men feared it would threaten social cohesion and their desire for death to be pro patria, for one’s country. This is evident from Greek state funeral records, such as that in Kerameikos, the Athens cemetery, in which female lamenters are only briefly mentioned, suddenly peripheral to the ritual they had previously orchestrated.
The trend of removing women from the centre of death is not exclusive to Ancient Greece. While some cultures, such as the Assyrians, fought to preserve the role of female lamenters, others have been unable to do so.As Richard Fitzpatrick reported in the Irish Examiner in 2016, in Ireland, the tradition of female keeners, who wail in grief, began to die out in the mid-20th century. In the United States, male funeral directors replaced the long-standing tradition of female layers-out. Women were left behind, as the funeral directors attempted and succeeded at monetising the death industry, a legacy that continues to haunt the recently bereaved, who must deal with costly funeral arrangements.
Today, however, we find ourselves in the midst of a death renaissance, spearheaded by morticians, activists and artisans alike – a majority of whom are women. Ancient mourning rituals and traditions are resurging. Perhaps the role of the female song leader as a spiritual caster of spells will find its way back, too.
Arun Shourie is an unflinching seeker. He has an exemplary ability to face the toughest questions. After a bracing meditation on the problem of suffering in Does He Know a Mother’s Heart (2011), Shourie now turns to Preparing for Death. There used to be a joke that the purpose of literature is to prepare you for the good life, while the purpose of philosophy is to prepare you for the good death. But it is hard to understand our own extinction. Broadly speaking, two diametrically opposite views are invoked to reconcile us to death. One is that we don’t really die; in some form, through an incorporeal soul or something, we continue to exist. The other unflinchingly accepts that we just are evanescent matter and nothing else. Both approaches address the question of dying by simply saying “there is nothing to it.” There is something to this strategy, but it cannot make sense of the significance of life. It seems we can either make sense of life or of death, but not of both.
Shourie’s book takes a brilliantly different pathway. The book has three distinct themes. The first, the most powerful and meditative section of the book is not so much about death as the process of dying. He documents with detail, “great souls” experiencing the often painful dissolution of their own body — the Buddha, Ramkrishna Paramhansa, Ramana Maharshi, Mahatma Gandhi, and Vinoba Bhave, and, as a cameo, Kasturba. All of them give lie to Sigmund Freud’s dictum that no one can contemplate their own death. But what emerges from these accounts is not so much the conclusion that they all faced death unflinchingly; most of them have a premonition. It is also not about capturing the moment where the good death is leaving the world calmly. It is rather what the suffering body does to consciousness, all the memories and hard decisions it forces on us.
But the relationship between the body and consciousness goes in two different directions at once. On the one hand this suffering is productive: consciousness works through this pain. On the other hand, even the most exalted soul does not escape the utter abjection of the body. The most poignant moment in this section is not the calm and plenitude with which these exalted souls face death; it is the moments where even the most powerful souls are reduced to abjection by the constraints of the body. The only one rare occasion where Ramana Maharshi ever loses his cool is in his now utter dependence on others for most basic bodily functions. The problem of dying is not that you cannot ignore the body; it is that the body does not ignore you.
The second theme of the book is to take a sharp scalpel to false comforters of all religions and philosophies that promise the everlasting soul, or the preservation of bodies only to subject them to torment in hell. This metaphysical baggage makes dealing with death harder and is a total distraction. This section is less generous in its interpretive sympathies. The third theme of the book, interspersed in various parts, is about the discipline of dealing with your own body as it is in the process of dying. The book impressively marshals a variety of sources, from the Tibetan Book of the Dead, with its incredible imaginative exercises that make you take in the whole of existence, to Jain sources of Sallekhana, and various meditative techniques to inculcate a certain kind of mindfulness. But mostly one gets the sense that the ultimate preparation for death is simply love, something that can endow the evanescent moment with significance.
But this is a seeker’s book. It is in parts profound probing, honest but not dogmatic. Its immense value comes from the fact that the book is both a book and an anthology on death, with extracts from not just the words of those experiencing the process of dying, but an astonishing range of sources: from Fernando Pessoa to Michel de Montaigne, from yoga to the Tibetan Book of the Dead. For the politically inclined, there is an ambivalently revealing account of the Prime Minister’s visit to Shourie while he was in the ICU. All throughout, the book is laced with judiciously selected poetry: the startling moment where Gandhi recites the Urdu couplet to Manu: Hai baha- e-bagh-e duniya chand roz/ Dekh lo iska tamasha chand roz, a register you might associate more with Guru Dutt than Gandhi. There is a lot of Kabir, of Basho poetry and haikus. One stunning one: Circling higher and higher/At last the hawk pulls its shadow/From the world.
This haiku caught my attention because I happened to be reading a stunning essay by Arindam Chakrabarti at the same time, “Dream, Death and Death Within A Dream”, in Imaginations of Death and the Beyond in India and Europe (2018), a volume edited by Sudhir Kakar and Gunter Blamberger, that reads as a great philosophical complement to this one. That volume has a powerful piece by another brilliant philosopher, Jonardan Ganeri, on illusions of immortality that deals with a source Shourie cites at length: Pessoa. Chakrabarti’s essay ends with the insight of Yoga Vashishtha: To be born is to have been dead once and to be due to die again. Shourie is perhaps right: Can we really unravel what it means for the hawk to pull its shadow from the world? Does the shadow reappear if it flies lower?
One needs to put oneself in the sandals of a dying Greek to understand the mind frame of the ancient Greeks and to understand why they did the things that they did. Also, one needs to live an ancient Greek death following all the rites of passage and the burial laws.
The ancient Greeks held certain ideas about death. One of the most characteristic motifs that people find on ancient Greek tombstones is the handshake between the living and dead. Both figures invariably exhibit a dignified calm. That’s what Greek tragedy is all about—looking death squarely in the eye. As a Greek, they knew that terrible things happen; and they knew, too, that by confronting them head-on, they’d be able to deal with them and get on with life. One could posit that the Greeks got it just right.
But one needs to put oneself in the sandals of a dying Greek to understand it. It’s an unpleasant thought, but there’s no escaping it if one wants to fully experience the other side of history.
The Role of a Physician in Death
Let’s assume one is dying in one’s home, surrounded by one’s relatives, including young children. There won’t be any physician at hand to give painkillers.
A physician may have offered treatment in the earlier stages of sickness, but once it became inevitable that there could only be one outcome, the medical profession had nothing to offer anymore.
It’s also extremely unlikely that a physician would be called in to put one out of one’s misery by euthanasia, a coined word of Greek etymology meaning ‘good death’, but which has no ancient Greek equivalent. In fact, the Hippocratic Oath, which was probably widely adopted, enjoined upon those physicians who took it “not to administer a poison to anybody who asked for one and not to propose such a course”. So let’s hope that one’s final illness is short and painless.
The Role of Gods in Death
The poet Keats has a wonderful line in Ode to a Nightingale: “I have been half in love with easeful death”. The Greeks conceived of easeful death in the form of the God Apollo, who came to strike them down with his so-called ‘gentle arrows’. That’s the best that he or any other of the gods had to offer. They certainly didn’t have any consolation to give someone.
In Euripides’ play the Hippolytus, when Hippolytus is dying, the goddess Artemis, to whom he has devoted himself exclusively all his life and with whom he’s had a very close relationship, bids him farewell. She explains to him that it’s not lawful for a deity to be present at the death because the pollution that a corpse releases would taint her.
The one god who may have taken some slight interest in the fate of the dying is the healing God Asclepius. When Socrates passes from this world to the next in Plato’s dialogue the Crito, he has this to say, “I owe a cock to Asclepius. See that it’s paid.” Cocks were sacrificed to Asclepius. Socrates may be indicating that Asclepius eased his passing, although it’s possible, too, that he’s merely suggesting philosophically that death is a ‘cure’ for life.
The First Rite of Passage: Prothesis
in ancient Greece, as soon as one died, the women in one’s family began keening and ululating so that everyone in the neighborhood knew of the individual’s demise. It was the women, too, who took charge of one’s body and prepared it for burial. They closed one’s mouth and eyes, tied a chin strap around one’s head and chin to prevent the jaw from sagging; they washed the whole body, anointed it with olive oil; they clothed the body and wrapped it in a winding sheet, leaving only one’s head exposed.
Then they laid the body on a couch with one’s head propped up on a pillow and one’s feet facing the door. After getting all this done, they sang dirges in one’s honor.
This is the scene that is depicted on the very earliest Greek vases with figurative decoration. It’s called the prothesis, which literally means the laying out of the body. It represents the first stage in the process that will take one from this world to the next, ‘from here to there’, as the Greeks put it. Meanwhile, relatives and friends would call at the house and join in the grieving.
The Second Rite of Passage: Ekphora
The second rite of passage is the ekphora. Ekphora means literally ‘the carrying out of one’s body’—specifically from one’s home to one’s place of burial. According to Athenian law, the ekphora had to take place within three days of one’s death, although in hot weather it’s likely that it would have taken place much sooner. The ekphora had to take place before sunrise so that it wouldn’t create a public nuisance.
If one was wealthy, one’s body would be transported in a cart or carriage drawn by horses. This scene is also depicted on the earliest vases with figurative decoration. Professional undertakers might also be employed to bear the corpse and break up the ground for burial. These professionals were known as ‘ladder men’ klimakophoroi, because they’d lay one’s body on a ladder, which they carried horizontally.
If professional undertakers were employed, they wouldn’t have any physical contact with the family members before this phase. The Greeks would have been shocked and appalled by the idea of handing over one’s body to professionals to prepare it for burial.
The Third Rite of Passage: Burial
It was one’s relatives who conducted the burial service. No priests were present either. Priests were debarred for exactly the same reason that Artemis absented herself from the dying Hippolytus, so as not to incur pollution. Because if they incurred pollution, they might transmit it to the gods.
Absolutely nothing is known about the details of the burial service. Truth be told, it’s not even known if there was a burial service as such. If any traditional words were spoken, they were not recorded. Both inhumation and cremation were practiced, although cremation, being more costly, was seen as more prestigious. If one was cremated, then one’s relatives would gather the ashes and place them in an urn, which they then would bury along with the grave gifts.
The commonest grave gift was pottery. In fact, that’s why so many high-quality Greek vases have survived intact—because they were placed intact in the ground.
Over time, however, the Greeks became more stingy. Chances are, if one died in the 4th century B.C., all one would get is a couple of oil flasks known as lêkythoi filled with olive oil—olive oil was regarded as a luxury item. Some Greeks, however, were so stingy that they purchased lêkythoi with a smaller internal container to save them the expense of filling the whole vase with oil. Supposedly, they thought the dead wouldn’t notice.
As soon as the filling of the grave was done, they’d erect a grave marker over it. After completing the third and final rite of passage, all the mourners would return to the grieving home for a commemorative banquet.
The Burial Laws
Since one’s corpse was regarded as a source of pollution—the Greek word for the pollution is miasma, which means much the same in English—one had to be buried outside the city walls. In the ancient Greece, burial within a settlement was extremely rare after the 8th century B.C. The same was true of Rome. The earliest Roman law code, the Law of the Twelve Tables, dated 450 B.C., contains the provision, “The dead shall not be buried or burnt inside the city.”
It is not certain, but the origins of the belief in pollution may be connected with a kind of primitive sense of hygiene. Dead one’s relatives and anyone else who had come into contact with the corpse were debarred from participation in any activities outside the home until the corpse had undergone purification.
Reintegration into the community for mourners didn’t take place until several weeks after the funeral. One’s relatives also had to take measures to prevent the polluting effect of one’s corpse from seeping into the community. That included providing a bowl of water brought from outside the house so that visitors could purify themselves on leaving.
Common Questions About Living the Ancient Greek Death
Q: What are the three stages of an ancient Greek funeral?
The three stages are the laying out or the prothesis, the funeral procession or the ekphora, and the burial or the Interment.
Q: How did the Greeks honor the dead?
Greeks honored the dead by following the three rites of passage, by building the tombs in Ceramicus, the Potter’s Quarter, and by offering the grave goods.
Q: How did Greeks prepare for the afterlife?
Greeks prepared for the afterlife by following the three rites of passage and offering the grave goods.
Q: What was the burial law in ancient Greece?
According to the burial law in ancient Greece, one had to be buried outside the city walls.
Grieving is difficult. Grieving during a pandemic even more so.
In the Islamic tradition, a person’s passing is marked with an elaborate and symbolic funeral. But what happens to those traditions when the world is put on pause, and when tragedy seems never-ending?
Two Muslim leaders, Ahmed Ali and Payman Amiri, share their stories on how they’ve had to adjust their practices in the time of COVID-19, and how mourning has changed in their communities. They tell Scienceline about the symbolism involved in a typical Islamic funeral, what the transition has been like as the pandemic has ramped up and their experiences of having to deal with the dead while mourners grieve from afar.
Hannah Seo: Each of our lives are marked with landmarks in time: birth, maybe a graduation, perhaps a marriage and a few anniversaries…In the Islamic tradition, one of the most important of these events is actually someone’s death.
Payman Amiri: In our culture and tradition. Dying is part of life.
Hannah Seo: This is Payman Amiri, he’s the chairman at the Islamic Cultural Center of Northern California, where he also works as an Imam. Imams are community leaders in Islam whose duties include teaching the Quran, leading prayers, and generally guiding the members of their communities. One of his duties is managing Islamic funeral services.
Payman Amiri: When somebody dies, you know, we try to sort of do that celebration of life, you know, like very formal in a big event and you just look at these family members that they are traveling with their loss.
Hannah Seo: But since COVID-19 spread across the nation, these funerals look vastly different.
Hannah Seo: This is Distanced, Scienceline’s Special Project about how different communities are responding to the coronavirus pandemic. In this installment, we’re looking at how the Islamic community has had to adapt its funeral services, which are important religious events.
Hannah Seo: Islamic funerals aren’t simple. They’re involved, meaningful, and the whole process can span up to several days.
Payman Amiri: The services include the washing of the body for the deceased person has to be washed in a proper way and they get treated with proper spices and herbs is a traditional thing for you. You put it on your skin and then you cover them in a white shroud…
Hannah Seo: He says that all the steps in a proper funeral service are imbued with history and symbolism.
(Guitar fades out)
Payman Amiri: So in our tradition, we believe we came from God, and our return is towards God. And so when you want to give them back, you want them to be washed clean. It has to be a white shroud, it has to be simple because every man and woman will go back to that white shroud. So it’s a symbol of humility.
Hannah Seo: Every aspect of an Islamic funeral is thought through, even the material…
Payman Amiri: It has to be cotton, it’s just everyone is treated equally because, you know, in God’s eye, everyone is equal.
Hannah Seo: Once the body is washed, the next part of the ritual can begin.
Payman Amiri: The body gets transferred to the cemetery, the body gets buried, facing toward Mecca, which is the direction all Muslims pray. And then you get the family members to, to say goodbye by putting flowers in the grave.
Hannah Seo: Or at least, that’s how things are supposed to be done.
For Payman, everything changed starting in early February, when he got a surprising call from a family in Santa Clara.
Payman Amiri: When she passed away and her family contacted us. It was the first case of community infection, and so it was a big deal.
Hannah Seo: Azar Ahrabi, a 68-year-old muslim woman from Santa Clara, California was initially diagnosed with pneumonia, but passed away from COVID-19 on March 9th. At the time, people thought she was the very first case of local community transmission of the new coronavirus in the county, but later, local health officials found two other cases who passed away before Azar’s case even came to light.
(Guitar music fade out)
Originally, Payman was supposed to arrange Azar’s funeral. But the virus, and fear of transmission meant that everyone had to take new precautions.
Payman Amiri: What happens if somebody dies with COVID they have to be in body bags, which were a thick bag with a zipper, and the body was in there. And then there are certain people who could only handle the body they have to be fully covered in PPE.
Hannah Seo: PPE is personal protective equipment: masks, gloves, etc. Suddenly mourning went from something close and intimate to something clinical, impersonal.
Payman Amiri: In our tradition, when somebody passes away, you greet the family with hugs and kisses and you hold on tight. And, of course, post COVID-19 nobody could do this.
Hannah Seo: And the moment that helps bring closure to the whole thing is usually a gathering.
Payman Amiri: Usually a lot of people show up in these memorial services, and it’s always the dinner. At the dinner table a lot of people share memories of the deceased person and it sort of helps the survivors put an end to that chapter.
Hannah Seo: But of course the pandemic has rendered these practices impossible. With mosques, funeral homes, and various businesses shut down, that closure is hard to come by.
Payman’s struggles in the throes of the pandemic are not unique — far from it. Imams across countries have had to adjust in ways they never imagined.
Ahmed Ali: We had to go in people’s home, pick up the deceased. We went into the hospitals, we pick up bodies from there.
Hannah Seo: That’s Ahmed Ali, an imam in Brooklyn, NY. He says imams, as leaders of the community, have had to step up and show up for their people. Masjids and mosques, the usual places of worship and congregation for muslims, closed. Communities were left floundering, and only a few people were left to pick up the slack. For Ahmed, it’s been a lot to take over.
Ahmed Ali: Usually the imam’s job is to just lead the funeral prayer and rest the work is done by the funeral home, but all the employees left in the very beginning of this pandemic. And people were scared because they didn’t know how to protect themselves from this virus and nobody knew what actually this virus is. So, they called me and they say, ‘Imam, can you come and help?’
Hannah Seo: Shouldering all the roles himself, Ahmed became body collector, mortician, funeral director — you name it. And at times, it was gruesome.
Ahmed Ali: When we receive the body from hospital, usually they have all the IVs attached. And if the person was in critical condition, then they have tubes inside their mouth. And some time, when we remove the IVs, the blood start coming.
Hannah Seo: Ahmed says there were times he’d have to enter storage units with racks of bodies, checking toe tags to find the right person. It took its toll, and the burden was immense.
Ahmed Ali: It’s not an easy thing. So you can say it takes about two hour to wash one body. This was really difficult because picking up a body and taking it into the funeral home then unload it then put on a table, wash it, put inside the piece of cloth and then put it back inside the casket, then take it for the funeral prayer, then go to the cemetery lower down the body inside the grave. So this all work is actually really difficult.
Hannah Seo: If this seems like so incredibly much for one person to take on, that’s because it is. But Ahmed couldn’t turn away…
Ahmed Ali: I didn’t say no because this is a responsibility of an imam, that whenever things go, this kind of pandemic, then we have to show that we actually care for our community.
Hannah Seo: Comforting others is easier said than done, especially when you see your community hurting, with no power to change things.
Payman Amiri: I get emotional when [I know when] I do these services to start with because you see, you know, the family is crying and grieving when you feel for them.
(Guitar music fade out)
Hannah Seo: Recreating that connection and support during the pandemic, a time of intense disconnection, is challenging. The emotional burden of conducting a funeral is hard enough without the impediments of social distancing and Zoom preventing everyone from mourning the way they deserve to.
Ahmed Ali: Well, a lot of family members, they did use the Zoom and FaceTime and other apps to show the funeral service to their families around the world. I think, that’s an honor for me that I was able to help those families.
Hannah Seo: Ahmed Ali has led countless services all by himself, with no mourners or relatives around to claim the decedent as their own.
Ahmed Ali: Whenever I got a body with no family member, then I used to record a clip when we lower the body inside the cemetery.
Hannah Seo: Ahmed recorded these services in case friends or family came later, in case they came and wanted something to remember their loved one’s passing.
Ahmed Ali: But there are many clips I recorded and nobody ever asked for them. It’s sad because, you know, I was leading the prayer, I don’t know that person. But I was just there because, you know, I know that that person is a Muslim and a family to me.
Hannah Seo: With many states reopening, Payman and Ahmed’s lives have returned to some form of normalcy. In fact Payman recently had to organize the burial for another COVID-19 victim; this time, however, he was able to carry out a full service for the grieving family.
Things may have gotten better, but Payman and Ahmed are still anxious about the situation. The worst may be behind them, but helping families process their loss is work that is never done.
Ahmed Ali: I as an imam just was able to stand next to them and tell them that, you know, this is reality of life. And now all we can do is pray for this deceased brother or sister.
(Prayer and guitar music in background)
Hannah Seo: This episode was reported by Jonathan Moens and me, Hannah Seo, for Scienceline. Thanks to both Payman Amiri and Ahmed Ali for sharing their stories.
Humanity has done a pretty good job of recording its collective history over the past two or three thousand years. Earlier time periods, though, are still very much shrouded in mystery. Now, a groundbreaking new archeological discovery in Indonesia is revealing secrets from 8,000 years ago.
Archeologists from The Australian National University have discovered an ancient child burial site located on Alor Island, Indonesia. While a funeral for a child is no doubt a morose and depressing event in any century, this unearthing is providing some invaluable insight on early mid-Holocene era cultural and burial practices.
Stunning burial practices unearthed
According to lead researcher Dr. Sofia Samper Carro, it’s clear that the child was laid to rest with a formal ceremony of some kind. The research team estimates the child was between four and eight years-old at the time of death.
“Ochre pigment was applied to the cheeks and forehead and an ochre-colored cobble stone was placed under the child’s head when they were buried,” she says in a university release. “Child burials are very rare and this complete burial is the only one from this time period,”
“From 3,000 years ago to modern times, we start seeing more child burials and these are very well studied. But, with nothing from the early Holocene period, we just don’t know how people of this era treated their dead children. This find will change that.”
Of particular note is the fact that the child’s arms and legs appear to have been removed and stored elsewhere before the rest of the body was buried. This sounds rather odd from a modern perspective, but researchers say it isn’t wholly unprecedented.
“The lack of long bones is a practice that has been documented in several other burials from a similar time period in Java, Borneo and Flores, but this is the first time we have seen it in a child’s burial,” Dr. Carro adds.
Why did ancient cultures remove arms and legs before burials?
The answer is probably lost to the sands of time, but researchers theorize some form of religion or spiritual belief is a likely explanation.
“We don’t know why long bone removal was practiced, but it’s likely some aspect of the belief system of the people who lived at this time,” Carro adds.
While teeth examinations project the child as being around six to eight years-old, the full skeleton appears to be closer to four or five years-old.
“We want to do some further paleo-health research to find out if this smaller skeleton is related to diet or the environment or possibly to being genetically isolated on an island,” the lead researcher comments. “My earlier work from Alor showed adult skulls were also small. These hunter-gatherers had a mainly marine diet and there is evidence to suggest protein saturation from a single food source can cause symptoms of mal-nourishment, which affects growth. However, they could have been eating other terrestrial resources such as tubers.”
“By comparing other adult burials we have found from the same time period with this child burial in a future project, we hope to build a chronology and general view of burial practices in this region from between 12,000 to 7,000 years ago which at the moment is still scant.”
The LGBTQ+ community has been among the groups historically underserved by hospice, with mistrust of the health care system at large and provider bias as leading roadblocks to quality end-of-life care. Hospice providers are increasingly working to better understand the LGBTQ+ population and improve access to care.
Issues of equity, inclusion and diversity have plagued the nation’s health care system. Providers of all walks are reaching deeper into the roots of disparities to understand barriers and expand care among underserved African American, Hispanic, Jewish and LGBTQ+ communities. While widespread data is scarce, available research indicates that the LGBTQ+ population is among those groups under-utilizing hospice care. According to a 2018 AARP study, 60% of the LGBTQ+ community are concerned about a lack of sensitivity to their needs among health care providers.
“When LGBTQ+ seniors need to access long-term care, most of them do not don’t feel safe and our health system in many places doesn’t make them feel safe,” said Ruth Thompson, national hospice medical director at Elara Caring during a session at the National Hospice and Palliative Care Organization (NHPCO) Interdisciplinary Conference. “We may have no idea that we’re taking care of people who are gay, lesbian, transgender and bisexual, but we are. It’s not unusual that they are not going to share with you that part of their personal history, which is really unfortunate because it’s who they are. The history of discrimination and poor education of the health care system really has had a profound effect on these people and compounded their fears. This population of people tend to have worse health outcomes as compared to their heterosexual and cisgender peers.”
With barriers such as patients’ fear of discrimination and general mistrust, hospice providers will need to build up awareness and break down biases around gender identity and sexual orientation to foster greater trust among underserved LGBTQ+ communities. A general lack of understanding and awareness among providers, along with stigmas, stereotypes and biases have been drivers of under utilization.
“No one is asking for special care or special treatment,” said Michael Kammer, medical social worker and bereavement counseling professional at Ohio’s Hospice of Dayton, during the conference session. “We just want care that takes into consideration the unique needs, concerns and experiences that we have had just like we do for any other minority population. We’re working on developing the awareness and ability to identify and join with people in the LGBTQ community. We need to shift our thinking about this from seeing the LGBTQ population as a special population to more inclusive care. Everyone needs the same specialized care, and it requires self-awareness on our part to shift how we perceive these groups and become aware of our own implicit biases, and being able to better interact with and support all our patients.”
Expanding education and awareness among hospice staff regarding the challenges, concerns and needs could extend reach for LGBTQ+ community members. Older LGBTQ adults often face issues such as economic insecurity, reduced caregiving support networks and misconceptions around sexual orientation and gender identity.
Hospice providers can improve access and experience of care by shifting organizational cultures and patient care practices, with executives leading the charge on deeper integration of LGBTQ+ education.
“In order to be successful and transform your organization’s culture, you must really start from the top,” said Kammer. “There needs to be buy-in at that executive leadership level. This requires a lifelong commitment, self-critique and self-evaluation and being culturally humble so that we can become aware of our implicit biases and mitigate those to provide truly person-centered care. This is not a one-and-done activity.”
Addressing gender identity and sexual orientation during the patient admission processes is one strategy toward greater LGBTQ+ inclusion in the hospice space. Providers will need to look beyond the scope of information on electronic health records to better understand how aspects such as gender identities and personal pronoun preferences can impact the experience and quality of care for LGBTQ+ patients.
Despite increasing advocacy, the field has much room to grow when it comes to improving cultural understanding and learning the specific social determinants of health for LGBTQ+ communities.
“People are struggling with LGBTQ+ issues that are impacting their psychosocial and spiritual situations, and it’s really critical that those patient discussions remain respectful,” said Thompson. “You can identify champions and have a team willing to stand up and make sure that people are having respectful conversations around care goals. When people are reaching the end of life, it’s important that they can be who they are and be with who they love. Those can really be challenges for the senior population because our LGBTQ+ elders are really the group of people who experienced a lot of that historical discrimination before the Gay Rights Movement many years ago. We’ve come a long way since then, but we still have a long way to go.”