As Americans get vaccinated, COVID-19 climbs in India. Inequity is at work.

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“I will carry the burden forever.”

These are the words of Avatans Kumar, who was unable to perform the last funeral rites for his father, who died of COVID-19 complications during the summer of 2020 in Mumbai, India.

As the oldest of four children, Kumar would have been responsible for performing these last rites. But with global lockdowns, neither he nor any of his siblings were able to be with their father at his passing.

“Who can take [that burden] from me? It will remain on my soul,” says Kumar. “He led a good life. He didn’t deserve this.”

The performance of last rites, known as Antyesti or Antim Sanskar, is a sacred practice in Hinduism.

It’s been 15 months of reminiscing of a time before COVID-19. Any other year, travelers could have easily visited India, but not this year.

Many Indian expats feel trapped and helpless, unable to visit sick or aging parents in their home country. They’re unable to coordinate care efforts from afar, or as in Kumar’s case, to perform last rites for a parent.

Atlanta-based journalist Archith Sheshadri had a different experience. His family was visiting India when the pandemic first started in 2020, but they managed to return safely to the United States.

Since then, Sheshadri has actively reported on the impact of the pandemic on both sides of the globe, and he has observed the stark contrast between the United States and India.

“In April 2021, while most Americans were eligible or already vaccinated (about 40 percent), India was only at a 2 percent vaccination rate,” he says. “How ironic that the United States has a plethora of vaccines with a large group still hesitating to take the dose.”

Akashi Sahasrabuddhe’s (name changed) bed-ridden 84-year-old mother developed COVID-19 despite round-the-clock care. The infection revealed a number of previously undiagnosed health complications.

Although the elder Sahasrabuddhe has since recovered from COVID-19, her health complications mean her life is still in danger.

Sahasrabuddhe requested anonymity to protect her siblings and extended family from this reality, fearing they might attempt dangerous travel plans to visit the ailing matriarch when nothing can be done.

In India, access to care varies widely from region to region. It’s also affected by social and political influence.

Shanti Rao (name changed) of Bangalore, India, recently learned that her father tested positive for COVID-19. Their local hospital had a ratio of 1 nurse to 8 patients, and the overburdened doctors weren’t able to visit each patient.

Rao’s family arranged for the expensive option of an at-home intensive care unit (ICU) with routine telehealth services from the local health department. Rao admitted that their family’s financial position is what made this possible.

But in some cases, it isn’t easy to find care.

When Ajay Samant contracted COVID-19, the Samant family found a bed for him in an ICU 300 kilometers, or 186 miles, away.

As a middle class family, they weren’t able to find a local option for care and had to resort to being temporarily displaced so Samant could get the care he needed. The rest of the family lived in temporary housing nearby while he recovered.

Kumar, a Chicago-based columnist, remains particularly critical of socio-economic inequities that worsened the crisis.

“The rich can jump the line and have the resources to make noise about being sick, while the poor have no one to speak for them,” he says.

The crisis has also exposed a major shortage of trained staff and reliable medical infrastructure. In a country of 1.3 billion people, this is nothing short of a health crisis.

According to a report by the Migration Policy Institute, India has been the world’s leading source for some of the best medically-trained staff, like doctors, physicians, and nurses.

In a health crisis of such magnitude, there simply aren’t enough trained medical staff left in India to take it on.

The irony isn’t lost on most Indians.

The observations from Rao, Sheshadri, and Kumar expose the inequities of access to medical care — not only in terms of trained physicians or better equipped facilities, but in terms of a fundamental inequality from the affordability of any kind of medical care.

As part of a panel at the virtual Jaipur Literary Festival, Yamini Aiyar, the president of the Center for Policy Research in New Delhi, critiqued both local and international responses to the COVID-19 crisis.

She pointed out that help has been most urgently needed at the grassroots level.

While there’s been an urgent need for vaccines in many countries, like India, citizens of other countries have vaccine hesitancy. According to Aiyar, this amounts to vaccine hoarding.

She encourages world leaders to consider a coordinated effort to provide an equitable response to the humanitarian crisis of the pandemic.

Many interview subjects requested anonymity.

Some didn’t want their families to find out. Others didn’t want their friends and neighbors to know they had experienced COVID-19, fearing stigmatization.

Still, others believed that their positions of privilege would be frowned upon within their communities in a country of stark imbalances.

Kumar cautiously noted that help for some has come with strings attached. This added to an atmosphere of mistrust, especially amongst those in the strongest deep.

Another Indian expat, Devangi Samarth (name changed) notes that, even though many organizations are doing good work, a lack of transparency has left people unsure of whom to trust.

Ordinary people in India are joining forces to address the humanitarian aspects of the crisis.

Apps, like Facebook, Twitter, WhatsApp, and Skype, have become lifelines of connection and information-sharing.

They’ve enabled grassroots efforts to mobilize resources, organize blood donations, arrange financial help, and source care for loved ones from afar. Efforts have popped up to arrange beds for the sick and source liquid cylinders and oxygen concentrators.

While the supply shortage remains, local initiatives, like Find A Bed, are connecting patients to beds as well. Large corporations, like Honeywell, Texas Instruments, Twitter, and others, are stepping up and donating funds and care units to hospitals across India.

Home-cooked meals

In some cases, volunteer cooks are stepping up to prepare home-cooked meals for entire families with COVID-19 for free or a nominal cost.

Many chefs are raising money to provide meals for people who feel ill, as well as medical professionals who care for COVID-19 patients.

Minneapolis-based chef and author Raghavan Iyer believes that the comfort of traditional Indian foods, many of which are based on the tradition of Ayurveda, can help the sick heal.

“The power of foods we grow up with shapes our psyche, especially when we’re faced with an illness,” says Iyer.

Ad hoc medical care

Aiyar also notes that, in many remote communities, women’s groups are providing initial care when institutional care isn’t readily available.

In a small village in central India, Nandurbar, a local doctor developed infrastructure to take on a COVID-19 surge even before the surge happened in September 2020.

Kumar noted that some doctors in rural areas have been offering telehealth services or treating patients free of charge.

Groups of Indian expats have taken the lead in collecting donations for procuring and shipping oxygen concentrators, liquid oxygen, PPE masks, and protective gear.

Still, so much more is needed.

“At the end of the day, we certainly don’t want to be complacent and think ‘Yes, I’m vaccinated,’ or ‘Yes, I can lower my mask,’ while people across the world are struggling to breathe,” Sheshadri says. “We must address the human problem.”

COVID-19 has affected everyone, yet no two experiences are the same.

In India, COVID-19 has deepened the income disparity, created food insecurity, and aggravated mental health concerns. Medical care, supplies, and humanitarian aid are desperately needed.

In a time when we might not be able to offer physical support, Mother Teresa’s words offer guidance: “Charity isn’t about pity. It’s about love.”

Nandita Godbole is an Atlanta-based, Indian-origin food writer and author of several cookbooks, including her latest, “Seven Pots of Tea: An Ayurvedic Approach to Sips & Nosh.” Find her books at venues where fine cookbooks are showcased, and follow her at @currycravings on any social media platform of your choice.