* Editorial 2
The Kerala government has been successful in putting the public health sector back on the rails
A health official applies hand sanitiser on a policewoman’s hand at the Ernakulam Junction Railway station. Thulasi Kakkat
Every year after the Union Budget, newspapers carry articles critiquing the abysmal allocation for the health sector. As the COVID-19 threat looms, doctors, healthcare professionals and state institutions have been regularly issuing guidelines on the precautions to be taken. However, the ubiquitous fault lines of India’s public healthcare infrastructure are being laid bare as we combat our latest adversary. In his book, Everybody Loves a Good Drought, veteran journalist P. Sainath poignantly details what it looks like to be a poor family that relies on government hospitals. He remarks how the 1994 plague in India got unprecedented media attention because unlike several other diseases, it couldn’t be restricted to rural areas and urban slums. The disease-causing bacteria had the audacity to enter elite spaces; in Sainath’s words, “Worse still, they (the bacteria) can board aircraft and fly club class to New York. Too many of the beautiful people felt threatened.” COVID-19, although a lot less dangerous than the plague, was brought to India by infected passengers flying in from affected nations. This argument is not to suggest that either of these diseases are to be taken lightly, but rather to shed light on how India responds differently to health requirements based on the social and class locations of those affected.
The advent of COVID-19 has led to a peculiar scenario wherein those who can otherwise afford private healthcare are now relying on government facilities to be quarantined and tested. It took a pandemic like COVID-19 for some to realise what most of India has been dealing with for decades. A case in point is the Agra woman who was falsely reported to have fled quarantine. In reality, she reportedly resisted the option of being isolated at a public health facility because “the sight of the unhygienic toilets made her retch”. This is an apt representation of the consequences of meagre health spending and lack of motivation from state institutions to strengthen public healthcare infrastructure. With a system that cannot even ensure fully functional toilets in public health centres, the COVID-19 challenge towers over our health administration.
Preparing for an outbreak
Given India’s record on public health, Kerala has been receiving praise for the way it is tackling the emergency. Be it the presence of health infrastructure prerequisites or its experience in handling the Nipah virus, the Kerala government’s preparedness for COVID-19 was relatively stronger than other States. Discussions on how to address it started as early as mid-January. When various countries started confirming cases, Kerala was the first State to draft measures for its containment. The measures became more stringent when the State reported its first case on January 30. Since then, the government has become more vigilant and taken proactive measures to trace people who have had primary and secondary contact with those who tested positive.
The situation became grave after a family that flew down from Italy tested positive for the virus. After vigorous tracing, we found that 719 people had come in contact with the first case. The government then tightened the norms for people returning from other countries. It started taking strict action against all those who were not revealing their travel history. All those who were in primary and secondary contact were tested and kept in isolation or home quarantined. The next step was to cancel big religious ceremonies. The government then gave a list of people under observation. More recently, the government started checking people at different entry points to the State. Healthcare workers are stationed at all check posts on roads to check travellers for the virus before they enter the city. A similar exercise is conducted for those taking trains.
If we are to learn from China and South Korea, the most efficient way to tackle the situation is to aggressively trace and test potential cases of COVID-19. Experts have said that the only reason South Korea was able to handle the crisis without imposing any lockdown was because of rampant testing. However, in order to follow these best practices, even Kerala, with superior mechanisms for healthcare, faces the challenge of limited resources and labs for testing. In such a situation, it is important to judiciously use available facilities and localise efforts. All of this can be achieved only through clear political will, strong public healthcare services and commitment on the part of people. It is important for citizens to closely follow measures prescribed by the government. An important step towards this is to ensure that people don’t go for testing without solid grounds. If they do, the public health facilities will be overwhelmed.
To ensure that people have access to the dos and don’ts for self-isolation, monitoring symptoms and reporting to health facilities at the right time, the Kerala government has launched a mobile application called GoK Direct. The Disha helpline has also been used for awareness generation. The ‘Break the Chain’ campaign advocates ideas of basic cleanliness and hygiene. This attempt to bring about a behavioural change is gaining traction across the State and is also being picked up by the national media. Such precautionary measures and social distancing by citizens will buy some time and lighten the burden on government functionaries. This buffer period should be leveraged by the State government to strengthen testing facilities so that we reach a point where a maximum number of symptomatic individuals can be tested. In this context, based on the State government’s request, the Indian Council of Medical Research has sanctioned 10 testing centres in Kerala. The government is also planning to facilitate the setting up of more testing centres with the help of the private sector for meeting the required capacity.
Lessons from and for Kerala
That Kerala came up with a set of guidelines before the COVID-19 outbreak was possible because of its history of unswerving governmental support for public health. The administration has been serving as a catalyst for the development of health services. This is reflected in the expansion of health infrastructure — for example, setting up the National Institute of Virology’s unit in Alappuzha soon after the Nipah incident.
The epidemiological status of the State is currently characterised by the burden of both non-communicable diseases and increased incidence of communicable diseases in recent times. The monitoring system created by the government in public health infrastructure has been highly successful. It has helped healthcare officials to detect and combat diseases quickly. The healthcare system in Kerala is decentralised to achieve the potential gains of improvement in service delivery and access. Consequently, in the context of COVID-19, the State has been successful in tracing individual cases and implementing measures like the ‘Break the Chain’ campaign successfully.
Efforts are being made to provide infrastructure and quality services through the ‘Aardram Mission’, which focuses on developing primary health centres into family health centres. The government has been successful in putting the public health sector back on the rails.
K.K. Shailaja is Minister for Health and Social Justice, Government of Kerala
The sports pages are a metaphor for these times
COVID-19 has affected every sphere. At the Readers’ Editor Office, we had to stop readers from attending our editorial meetings and also cancel the Open House that we had planned to celebrate 50 years of this newspaper in Bengaluru. Apart from a perceptible decline in letters and calls, there is also pronounced anxiety everywhere. People are fervently hoping that this pandemic will end soon. This hour of crisis may also be used as an hour of reflection.
Physicist Freeman Dyson, who died early this year, was fond of reminding everyone about two different kinds of scientists: birds and frogs. Some scientists are birds who fly high to survey the broad vistas and establish unexpected links between different bits of the landscape. Others are frogs who prefer to be close to the ground, focussing on minute details. These two are not opposing trajectories; they are complementary paths.
If applied to journalism, Dyson’s classification may put most Editors in the bird category, but the Readers’ Editor in the frog category. An internal news ombudsman views and evaluates the world mainly through the pages of the newspaper. COVID-19 is hurting us on all fronts. From crippling our economy to immobilising us, the ramifications of the pandemic are beyond our comprehension. It may take a month or two to quantify the loss. In this hour of unknown hardship, the sports pages seem to be a metaphor for our times.
No sports events
There is a moratorium on sporting events. Some observers say that the 2020 Olympics to be held in Tokyo in July may be postponed. Sports writers usually compete with each other to grab the precious space for their reportage. When politics polarises people, it is sports that helps to break the silos, despite attempts by hyper-nationalists to inject jingoism in sports too.
I asked the Sports Editor, K.C. Vijaya Kumar, about how his team is managing when there is no sporting event to report. “Sports pages ideally thrive on kinetic energy through live reportage of matches supplemented with action-photographs. The other added elements are a sprinkling of analysis, a few features, and the odd pinch of nostalgia as and when a significant event’s anniversary comes to the fore. But largely the sports pages are of the here and now, of who won a match, of who scored the winning goal or the championship-winning forehand or the game-changing blistering hundred. But when sport ceases as it has in these grave times of the coronavirus pandemic, the sports pages are plunged into a vacuum,” he said.
With sports having hit the pause button globally, there is a dearth of live-action content. Understandably the sports pages had to be scaled down from three to two and the Sudoku grid was moved from the world page to the sports pages. “Even the feature-driven Weekend Sport page that appears on Saturdays, with its look-ahead perspective, well-curated by Senior Deputy Editor S. Ram Mahesh and embellished by Deputy National Design Editor S. Kannan, had to be suspended for now. Besides the periscope-gaze, reporters are also looking back with awe as anniversaries are culled out and written about, while the sports desk, headed by R. Narayanan, provides support through archival images and graphics,” said Mr. Vijaya Kumar.
Creating hope where there is despair
From George Orwell’s pithy article, “The sporting spirit” to Jorge Luis Borges biting one-liner — “Soccer is popular because stupidity is popular” — we have had criticisms of sport over the last century. What these thinkers did not bargain for was the possibility of suspension of sporting activity itself. In this bleak time, it is important to recall Nelson Mandela’s observation about sports. He said: “Sport has the power to change the world. It has the power to inspire, it has the power to unite people in a way that little else does. Sport can create hope, where once there was only despair.”
Sports journalism informs us that bleak realities do not mean despair alone. They suggest possibilities and potentials, alternatives and optimism. The absence of sporting events has forced the sports team to remember and reflect on multiple aspects of sport — from aesthetics to skills — that make the world of games an integral part of our life. In a sense, it is a language of grief that generates space for empathy, social action and shared values, which in turn create space for hope and transformation.
Sovereignty is subject to constraints
The UN High Commissioner for Human Rights, Michelle Bachelet, filed an application seeking to intervene as amicus curiae in the pending litigation in the Supreme Court against the Citizenship (Amendment) Act, 2019. That the case has attracted the attention of the international human rights agency is a matter of concern for the Indian government. On the other hand, the intervention may enable the Supreme Court to read in public international law principles in determining the constitutionality of CAA. Ultimately, this would assist in laying down the law on concepts of sovereignty in addition to determining the obligations of a nation-state to the international community at large.
The application is based on the belief that the High Commissioner’s intervention will provide the Court “with an overview of the international human rights norms and standards with respect to the state’s obligations to provide international protection to persons at risk of persecution in their countries of origin”. This application stands out for a number of reasons. First, this is a voluntary application rather than at the invitation of the Supreme Court. Second, she accepts that India is a state party and signatory to various international conventions including the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Culture Rights which contain important non-discrimination clauses, including on the ground of religion. India is obliged, under international law, to ensure that migrants in its territory or under its jurisdiction receive equal and non-discriminatory treatment regardless of their legal status or the documentations they possess.
In response, the External Affairs Ministry argued that “no foreign party has any locus standi on issues pertaining to India’s sovereignty”. The High Commissioner has filed similar amicus curiae briefs on issues of pubic importance before a range of international and national judicial fora. However, this intervention, if permitted, would serve as a precedent for a number of future applications. It would also provide an opportunity for the Supreme Court to lay down the law on whether such applications interfere with national sovereignty.
Sovereignty as responsibility
International Court of Justice judge James Crawford defines sovereignty as, among other things, the “capacity to exercise, to the exclusion of other states, state functions on or related to that territory, and includes the capacity to make binding commitments under international law” and states that “such sovereignty is exercisable by the governmental institutions established within the state”. The Preamble to the Constitution lays out the position, wherein the people of India have resolved to constitute Indian Republic into a sovereign and not just any one authority. As such, the courts (judiciary), the government (executive) and elected legislatures (legislature) are equally sovereign authorities. No one can claim exclusivity over sovereignty. Furthermore, Article 51 (c) of the Constitution directs the state to “foster respect for international law”.
According to the International Commission on Intervention and State Sovereignty, “national political authorities are responsible to the citizens internally and to the international community through the UN”. Therefore, it is trite to say that an authority’s right to sovereignty is not unfettered. It is subject to constraints including the responsibility to protect its citizenry and the larger international community. Furthermore, Article 14 extends the right to equality to all persons, which is wider than the definition of citizens. Even illegal immigrants shall, consequently, be treated by the government in a manner that ensures equal protection of Indian laws. It is hoped that the Supreme Court will conclude that the intervention is necessary as the Court would benefit from the High Commissioner’s expertise in public international law principles.
Manuraj Shunmugasundaram is an advocate (Madras High Court) and DMK spokesperson & Muthupandi Ganesan is Barrister-at-Law, U.K.