The initial on-site trainings led by Drs. Witcher and Adhikari, along with selected faculty, residents and students, in Nepal have built a strong foundation for success over the years. This consists of didactic subject-specific seminars hosted at Bir Hospital in Kathmandu, typically co-sponsored by the Nepalese Society of Neurosurgeons (NESON). These are paired with hands-on demonstrations using supplies donated by Carilion Clinic, Dr. Witcher and NESON, including complex spine and functional neurosurgery workshops. 

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Additionally, Dr Witcher and faculty see a high volume of clinic patients (Parkinson's Disease and complex spinal deformity) and select patients for operative intervention. They then lead operations at Bir Hospital, along with senior and junior Nepali faculty, to demonstrate the technique and directly serve the selected patients. In these surgeries, patient costs are partially sponsored, though implant costs (for example deep brain stimulation hardware) are the patient’s individual responsibility. As this is an indigent care facility, many of the patients cannot afford this treatment and must be turned away. Dr. WItcher wishes to expand the treatment option though direct sponsorship of hardware costs, so that, as more patients are directly served, local faculty develop expertise associated with repetition. This skill can then be taught to trainees, thus transferring the knowledge base to rising faculty and practitioners.

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Looking forward, Dr. Witcher hopes to expand upon the partnerships he has built to deliver more access to neurosurgery for the people of Nepal. While some wealthy Nepalese choose to seek neurosurgical care outside of Nepal, the vast majority of the population cannot afford to travel for medical assistance. 

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Building the reputation of Nepal neurosurgeons would also help those patients choose to stay and become walking testimony to the quality of care that can be provided in Nepal. Partnerships with American Universities such as Virginia Tech are a way of strengthening the reputation and brand of Nepalese neurosurgery, in addition to supporting knowledge transfer and the building of their skillsets. 

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Dr. Witcher is already starting to see the benefits of training the project has provided. “The core faculty I’ve been working with, including Professor Jha and Dr. Khadka, have already started teaching people in other centers to do the work.”