What’s it like to provide medical assistance in locations only accessible by foot?
Harini Sridhar, a fourth-year medical student at UNC School of Medicine, discovered the answer firsthand this summer. With the support of the Office of Global Health Education, she joined a group of 20 attending physicians, residents and medical students from around the world on a month-long expedition with the Himalayan Health Exchange.
Started in 1996, the Himalayan Health Exchange unites healthcare professionals and students passionate about global health to provide care to the underserved populations in select, remote areas of the Indian Himalayas and Indo-Tibetan Borderlands.
Sridhar and her group spent their time in Himachal Pradesh and Ladakh, areas nestled in the Himalayan region of India. They slept in tents at high altitudes in village centers or at monasteries where they provided patient care. Each day began with a trek to a clinic site, sometimes covering as much as seven kilometers (4.35 miles).
“We started seeing patients in groups of three or four with a resident or attending with us supervising,” Sridhar said. “One medical student would do the interview and take the history or physical and another medical student would scribe on the patient’s physical paper medical record.”
This setup provided Sridhar with invaluable hands-on experiences in unique clinical settings. One day, she saw close to 70 patients.
“People arrived with all sorts of concerns,” Sridhar said. “Some were gynecologic — I did a pelvic exam. Pretty regularly, I looked at people’s eyes and did a neuro exam. So it was truly any problem. It was a fully encompassing rotation.”
Performing medical exams in the Himalayas presented distinct challenges. There are no x-rays, blood tests or even Internet service to look up basic information. The group had to rely on each other and their clinical skills to provide patient-centered care without technology.
Aided by Himalayan Health Exchange translators, Sridhar had some touching interactions with her patients.
“I took the time to ask questions, be curious and learn from everything — the traditions of healing, the historical context of healthcare practices, the interplay of nature and health,” Sridhar said. “It was such an honor to spend the time with the community and bear witness to their stories. A lot of our patients were farmers — so people who are living such different lives from our own.”
Sridhar has always been passionate about global health. The Durham native traveled to Calcutta, India, in 2017, where she worked at a special needs school.
“Working with children with autism was the first time I felt so much meaning and purpose in my life,” Sridhar said. “I felt, ‘This is what I’m supposed to be doing.’”
She also had a positive experience during her third year, completing her clinical work on Central Campus in Chapel Hill. Her residents and attending physicians trusted her to take full ownership of the patients — interviewing, presenting cases, calling consults, writing notes and getting to the diagnosis.
Shaped by these experiences, Sridhar is applying to psychiatry for her residency. Over her time at UNC, she’s had the opportunity to work in clinical settings with Katie Napier, MD, a child psychiatrist. Napier has been an incredible mentor for Sridhar, particularly while working with children with autism.
“Harini is patient and empathetic and yet has a nuanced understanding of self, other and the space in between,” Napier said. “She has a remarkable ability for someone at her level of training to maintain calm, be a safe space, and manage a lot of things, people and feelings all at once.”
For now, Sridhar must wait until Match Day in March 2025 to find out where she will complete her residency. She’s ready for that next step with all the knowledge she’s gained over the past four years in the School of Medicine and during her summer journey with the Himalayan Health Exchange.
“I would love to do global health work in residency,” Sridhar said. “In psychiatry, it will look different from this rotation, but the clinical skills I developed — being present with patients, teamwork and and acclimatizing to new settings — will be very helpful as a psychiatrist.”