Two days into the first phase of nationwide lockdown imposed to contain the novel coronavirus disease (COVID-19) pandemic, a woman in a village in north Kerala went into labour. She wanted to seek medical care in Mangaluru, Karnataka, less than 20 minutes away from the village. Kasaragod, the nearest big town in Kerala, was more than 50 minutes away.
But the ambulance carrying her was halted at the interstate border by Karnataka Police — they had been ordered to not let anyone from Kasaragod district enter the state. After all, Kasargod, with 138 cases as on April 10, had been labelled a COVID-19 hotspot.
The woman gave birth to a girl inside the ambulance on way back to Kasaragod.
A day earlier, Abdul Hamid (60) from the same village was turned back at the border. He had suffered a cardiac arrest. After pleading with policemen for about 30 minutes, Hamid’s family took him to a primary health centre, where the doctor had only one thing to say — take him to Mangaluru.
Hamid died the same day. Nine more patients, including two Kannadigas, from Kasaragod district died in days up to April 10.
When the first phase of lockdown was imposed, inter-state movement of people and vehicles was banned, except transportation of essential goods and ambulances.
In some places, mounds of mud and excavators were placed in the middle of the road on Karnataka's side to curtail encroachment, a move strongly opposed by Kerala. As a result, scores of patients who relied on Mangaluru hospitals for procedures such as dialysis or chemotherapy were severely affected.
The Karnataka government, for a long time, maintained that it sealed the border to protect Mangaluru and the Dakshina Kannada district from the contagion. Entreaties from the Kerala government, mediation by Union ministers and orders by the Kerala High Court (HC) and the Supreme Court (SC) were not heeded — and the border remained closed.
Kerala HC asked the Centre to clear National Highway-66 leading to Mangaluru. Karnataka claimed it was beyond HC’s jurisdiction and approached SC for relief. The apex court then asked the Centre to find a solution as “any further delay could entail loss of precious lives of our citizens.”
On April 7, Karnataka allowed entry of critical patients from Kerala following a discussion between the chief secretaries of the two states.
But the decision came with certain riders — patients who carry COVID-19 certificate stating they tested negative for the virus along with a certificate stating the sought treatment was not available in Kerala would be allowed to enter. The patients should also be in a government ambulance.
But as the border opened up, stories of indifference cropped up. Several patients who were taken to a private hospital in Mangaluru alleged they were treated as suspected carriers of SARS-CoV-2 and bundled into an isolation ward of a designated hospital.
A woman with severe abdomen pain claimed she was not allowed access to a washroom, so she fled to back to Kerala. The hospital, however, refuted all claims.
According to a press release by this hospital, only six patients from Kerala sought treatment there until April 12. “…Some vested interests are trying to tarnish the image of the hospital during these testing times,” the release stated.
Kerala Chief Minister Pinarayi Vijayan assured its people of alternative treatment facilities elsewhere in the state. He added the government would airlift patients to bigger cities in Kerala, if needed.
Bad blood
As the situation spiralled into a near-humanitarian crisis, Union Minister DV Sadananda Gowda and former prime minister HD Deve Gowda offered to mediate.
The Janata Dal (Secular) patriarch reportedly said this was no “time to settle political scores”.
In response, Karnataka Chief Minister BS Yeddyurappa said any decision amounting to opening the border “would invite death.”
Yet, the move reflected the bad blood between the BJP-led Karnataka government and the CPI(M)-led Kerala government.
Karnataka BJP chief Nalin Kumar Kateel, who also represents Dakshina Kannada in the Lok Sabha, tweeted on April 2: “Kerala government takes pride in its model, but when it comes to healthcare, it depends on another state. This is unfortunate.”
The tweet triggered a campaign purportedly aimed at denting Kerala’s image as an achiever in development indexes. An older tweet by Communist Party India (Maoist) inviting Uttar Pradesh Chief Minister Yogi Adityanath to learn from Kerala’s healthcare achievements was rubbed in.
Pratap Simha, who represents Mysuru in Lok Sabha, accused Kerala of sneaking labourers out of the state in vegetable trucks.
Karnataka tread a thin line between politicising the pandemic and protecting their regional interest, A Narayana, professor of public policy at the Azim Premji University in Bengaluru, said.
“All states have closed their borders as a matter of emergency because they don’t want to strain their health facilities. However, this is not the right time to question Kerala’s dependence on Mangaluru for their health needs,” he said.
The political analyst said the barbs were part of a strategy aimed at BJP supporters on either side of the border. “While keeping their supporters in south Karnataka happy, BJP has to justify their act of closing the border to their supporters in Kerala.”
Narayana said his hometown Kasaragod was as dependent on Mangaluru as northern districts of Karnataka were on Hyderabad or Pune for their essential needs.
Borders a blur
Mangaluru has, for long, drawn patients from south India, especially north Kerala, owing to its robust healthcare system. The borders between Kasaragod and Mangalore — where Malayalam, Kannada, Konkani and Tulu speakers mingled — became blurry with time.
Many of them spoke at least three languages. Just about an hour’s drive from each other, the two towns knit a close web.
The people of Kasaragod have a shared history with Mangaluru and south Karnataka predating independence, according to Kasaragod legislator NA Nellikkunu.
Kasaragod and Mangaluru were under the Madras presidency till they were annexed to new states of Kerala and Mysore (later Karnataka) in 1956. “When it comes to healthcare needs, every family in Kasaragod has family doctors based in Mangaluru,” he said.
Nellikunnu claimed that the Dakshina Kannada administration’s decision to ferry all patients to one hospital was wrong since the majority from Kerala were follow-up patients with specific doctors who knew their case history better.
Kasaragod Medical Officer AV Ramdas said government hospital facilities were equipped to handle extra patients. “We have increased dialysis shifts in three block hospitals,” he said.
Meanwhile, Kerala has been more lenient with border controls. The state opened its border for residents of a Karnataka village lying close to Kerala’s Wayanad district to seek medical treatment.
“Arrangements have been made for people from Karnataka and Tamil Nadu border regions to seek treatment at hospitals in Wayanad district. These include those from Bairakuppa and Machur in Karnataka and Pandalur and Gudalur in Tamil Nadu. At least 29 people have come from Bairakuppa and 44 from Tamil Nadu to hospitals in Wayanad,” the Kerala Chief Minister said during a press briefing.