It's been about a month since Dr. Harika Yadav returned from providing medical care to Ukrainian refugees on the Polish border, and the young doctor said the experience not only made her a better physician, but also a stronger advocate for service opportunities in graduate medical education.
As a second-year internal medicine resident at the University of Tennessee College of Medicine Chattanooga, Yadav works up to 80 hours a week at Erlanger Health System - the residency program's affiliate - and gets three weeks of vacation a year. She decided to spend one of those weeks pursuing a personal and professional goal of providing medical aid to people involved in an international crisis.
Yadav was stationed at a refugee camp in Medyka - the busiest pedestrian border crossing between Poland and Ukraine - as a volunteer with an Israeli-run nongovernmental organization called Sauveteurs Sans Frontières or rescuers without borders.
The Sauveteurs Sans Frontières tent is one of two medical clinics at the camp and the first tent refugees encounter once crossing into Poland, so it's often their first stop when entering the country, she said.
Most of the refugees are women, children and family members of soldiers fleeing the Russian invasion or trying to find lost loved ones. Since she was caring primarily for civilians. Yadav said the patients she saw often needed treatment for chronic conditions, help getting medication, education or just someone to talk to.
Most had gone a long time without access to health care, she said.
"They're just normal people who have been completely uprooted from their daily life, and they've come across the border. Some people have family in places like France or other places that they're trying to get to, but some of them have none," she said.
The medical tent was stocked with drugs on the World Health Organization's list of essential medicines. Many of the drugs were donated because they had expired, which means they may have lost some potency but have no increased risk of harm compared to nonexpired drugs.
"They had probably every medication people could want," Yadav said. "Somebody came in because they ran out of their seizure medication, and they had that, too, which was kind of surprising to me."
She recalled one refugee, a middle-aged man from Mariupol named Sasha, who lost contact with his family after Russian forces decimated the city. He's been camped at the border crossing providing aid to other refugees as he tries to find his family.
"Anybody who comes from near his hometown, he'll ask them, 'Have you seen my family? Have you seen my family?' And it's heartbreaking, because it's somebody who has nothing, and he's still trying to give other people happiness by helping them across," Yadav said.
Sauveteurs Sans Frontières volunteers work in eight-hour shifts from either 8 a.m. to 4 p.m., 4 p.m. to midnight or midnight to 8 a.m. and typically treat about 30 patients per shift.
Once she started seeing patients, Yadav's first challenge was to overcome the language barrier. Refugees would often come into the tent, sit down and touch their arms.
"I thought that meant, 'My arm is broken.' Then I learned that that meant, 'Check my blood pressure,'" she said.
Although there were translators onsite, Yadav said Google Translate became her "best friend."
"People actually preferred that, because there wasn't a middle person in between. I could look them straight in the eye and talk to them," she said.
Yadav recalled a diabetic patient she treated who had a wound on his foot worn down to the bone. Because people with diabetes often have nerve damage that causes them to lose feeling in their feet, she said the wound was likely caused by him trudging across the country with an injury he didn't notice.
"A lot of these people have left their cars behind, so they actually come walking across their entire country to get to safety," she said. "By the time he got to us, it was pretty bad, and I think either culturally or in the situation they're in, their health is like their last priority."
The man needed surgery, which the medical tent isn't equipped to perform, but he refused to go to a hospital. So, the team cleaned and dressed his wound and gave him six weeks' worth of antibiotics to take with him.
She suspects the reason he didn't want to go to a hospital was because he didn't want to accept free help.
"That was a trend for a lot of people," Yadav said. "I realized that a lot of people don't have places to go, and they have a lot of questions. They just don't want to ask, just for pride's sake."
At first she didn't want to pry into people's lives, but Yadav said she learned that asking questions like whether patients have a safe place to go can help lead to better care, especially because the mental toll of the war was by far the biggest factor affecting the refugees' health.
"I realized over that week that a lot of patients manifest their stress as actual physical things, so a lot of those people that came in for blood pressure (checks) were just anxious and stressed," she said.
Yadav said she encounters similar situations in the United States when people who don't have health insurance or who can't afford care may have a lot of medical issues but don't want to go to a free clinic unless it's a last resort.
"I can incorporate all those questions - the way that you would ask and the way that you would approach those subjects - I can incorporate that everywhere, even here. And I'm going to for sure," she said.
Yadav said she hopes sharing her experience will encourage more residents to engage in service work either abroad or at home as well as make the process easier. After weeks struggling to find a volunteer group to join, she wound up messaging another doctor on Twitter who linked her with Sauveteurs Sans Frontières.
She said she also wants people to consider supporting that organization and Humanity First, the other medical clinic for refugees at the Medyka crossing, and wishes residency programs did more to support those who want to volunteer their time and skills but who may not have the resources.
"I did have some support, but I feel like there are a lot of residents who would want to go if we could incorporate that into residency programs. If I was going to do anything different in my career because of this, I would probably advocate more for that," she said, noting that she paid her own way but her program director let her leave work two days early for the trip.
Dr. Curtis Cary, internal medicine residency program director and associate professor of internal medicine and pediatrics at the University of Tennessee College of Medicine Chattanooga, said Yadav is an inspiration for other residents who would like to undertake similar service projects.
"I think many of them have these ideas and yearnings to do it, but they don't see it done necessarily, and for someone to take that initiative on their own, have an amazing life-changing experience and bring that back I think it's helpful for other people to see that impact," Cary said.
Even if residents can't afford to travel internationally, he said there are many service opportunities in the Chattanooga area.
"She was one of the few people that watched the news, saw what's going on and wanted to do something. Many of us feel kind of helpless, but I think her story can be hopeful," he said. "Even in the world around us, as dynamic as it is, we can still go out and do something good. And helping each other doesn't ever get old."