The Tribhuvan University Teaching Hospital, Kathmandu was the single site that the AOA and Orthopaedic Outreach coordinated supplies to following the 2015 earthquake, and was previously identified as a key site for engagement due to the capacity for a teaching component. The local network appeared weakened, sadly primary contacts had relocated and the program was required to adjust.

The strong in-country connections of Ausnep Australia directed the team to focus elsewhere and Sushma Koirala Memorial Hospital became an immediate focus, although outpatient clinic numbers were lower than expected. While many patients were suitable candidates for surgery, not all were forthcoming when the surgical option was offered. It appeared that the hiatus in visits has shifted local trust, and instead the family and village elders when consulted, chose traditional healing instead.

The inclusion of hand therapy remained a strong point, with a splinting and casting workshopdelivered by Outreach therapists Jade Wong & Stacey Fritsch, attended by 16 therapists from throughout the Kathmandu region. Finger and hand/wrist splinting techniques were taught in a highly interactive session. Donated supplies provided the necessary materials for the participants to practice on each other creating useful splints for a number of conditions.

Any program success requires local in-country leaders. In seeking alternative sites for future programs, we were introduced to Dr Shilu Shrestha, orthopaedic surgeon, Director of Hand and Reconstructive Surgery at the National Trauma Centre, Kathmandu, and currently the only female orthopaedic surgeon in Nepal. With a vision to create a strong program focusing on establishing a teaching centre of excellence for hand surgery in Kathmandu, with research collaboration, and long-term goals including the creation of the Nepal Hand Surgery Association, we sensed that this was the foundation to launch from in 2023.

Orthopaedic Outreach contributed alongside of Aus Nep Australia Limited, an Australian not-for-profit NGO with long-standing connections in Nepal, to maximise the impact of this visit. Aus Nep have been delivering various health camps in remote regions throughout Nepal for a number of years, with strong in-country connections.