Kasaragod: Just as the frail but fiery Daya Bai began her searing speech, an ambulance zipped past the protest site at Palakunnu near Bekal.

For the small Kasaragod crowd gathered to listen to the 82-year-old activist, the wail of the ambulance is plain white noise they have learned to ignore. According to the Ambulance Owners and Drivers Association (AODA), around 50 ambulances zig-zag Kasaragod district ferrying patients to hospitals in Mangaluru and Kannur. Kasaragod district does not have a hospital providing tertiary and trauma care.

The first siren has subsided, the next one has not yet arrived and the crowd is all ears for Daya Bai. "The government should be charged with culpable homicide," she boomed into the microphone. "It is the government's responsibility to ensure the right to life. But too many people in Kasaragod have died without treatment. We should make a list of people who have lost their lives to the government's apathy," she said.

Daya Bai was speaking at the mock celebration of the 'Making of Kasaragod Medical College'. The foundation stone for the project was laid by the then chief minister Oommen Chandy at Ukkinadka in Badiadka panchayat on November 30, 2013. Nine years on, the Rs 385-crore medical college hospital project is in limbo.

The civil contractor has abandoned the construction of the hospital block because his bills were not cleared.

An outpatient consultation service is run from the Academic Block but the only diagnosing equipment doctors have access to is the stethoscope. "Kasaragod medical college can at best be called a primary health centre," said Sreenath Sasi, coordinator of Movement for Better Kerala (MBK), a collective of socially committed professionals. Sreenath runs a startup in Bengaluru but drove down to Kasaragod for the protest.

The MBK turned a building under construction at Palakunnu into a protest site. "We wanted everybody to easily access the protest site. But at the same time, we wanted to drive home the point that the construction work of the medical college had stagnated," said A K Prakash, a Microsoft employee and member of MBK.

A few protesters cooked rice gruel and stitched up jackfruit leaf spoons in preparation for the day-long agitation.

The protest site also had an exhibition of cartoons drawn by members of MBK mocking the government's tall claims of Kerala being No. 1 in health care and also on the plight of patients, particularly endosulfan survivors, in Kasaragod district.

Today, Kasaragod is the only district without a tertiary health care facility even in the private sector, said Prakash.

The work on the medical colleges in Konni in Pathanamthitta started in the same year. "The Konni medical college admitted its first batch of students in November," he said.

Idukki medical college ran into trouble with the Medical Council of India in 2016 because of the lack of facilities for students but it has started admitting students this year.

Idukki, like Kasaragod, depends on medical colleges in the neighbouring district of Kottayam and Theni in Tamil Nadu.

Daya Bai said the people of Kasaragod were being repeatedly failed by its politicians because the people were not taking them to the task. "I have decided to take up the cause of Kasaragod because my conscience keeps pricking me. I have stopped writing my autobiography after visiting Kasaragod and seeing the plight of the people," she said.

Writing can wait. "It is time for action. It's time to be united. Parents should come forward. Youths should join forces for the cause," she said.

On October 2, Daya Bai went on an indefinite hunger strike demanding daycare centres for endosulfan survivors, a special medical camp to identify new endosulfan victims, and a full-fledged neurology department in the District Hospital.

She ended her hunger strike on the 18th day after the government agreed to her demands and gave in writing a time frame to implement the demands.

The special medical camp, which was last held in 2017, will be conducted by March 2023; and the neurology department in one year. "I want to believe the government will be true to its words," she said.