Finding My Flow: My Pursuit of Vascular Surgery in a Country Without Dedicated Vascular Surgery Training

By Dr. Swechha Bhatt

My love for vascular surgery began in the very first year of medical school, when I studied hemodynamics. The intricate balance of pressure, flow, and resistance fascinated me, and somehow it all made sense. I carried this love with me into my clinical years, where the subject transformed from textbook diagrams into real patients and real problems. 

In clinics, every vascular case felt like a puzzle waiting to be solved. I often describe vascular surgery as “plumbing: it’s pipes, and you connect pipes.” Yet behind that simple analogy, I began to see the enormous gaps in access and awareness that patients in my country face. 

Patients with peripheral arterial disease (PAD) would walk into our hospital with critically cold limbs, many at the point of requiring an amputation. I often wondered how different their lives could have been if they had recognized claudication earlier, or if someone had explained the difference between a muscle spasm and intermittent claudication. Dialysis patients routinely traveled for hours to reach us, but when they finally did, their first access was rarely an arteriovenous fistula. Instead, they ended up with temporary catheters that carried higher risks of infection and complications. 

I learned that there are only three surgeons in all of Nepal trained to operate on aortic diseases, and only about ten vascular surgeons nationwide, I felt a mix of frustration and determination not a single one of them is female. How sad is that? 

Despite the enormous need, aspiring surgeons face a nearly impossible pathway. At present, anyone wanting to pursue vascular surgery must complete three years of general surgery and another three years of cardiothoracic and vascular surgery training. The result? They end up stretched across specialties, expected to be general, cardiac, thoracic, and vascular surgeons all at once. It is no surprise that many choose not to pursue this track at all. In contrast, countries like Germany, the UK, and the US have long established dedicated vascular training because the specialty itself is so vast. They recognized that an integrated pathway was the only way to truly train competent vascular surgeons. 

In Nepal, however, the specialty continues to lose its charm. Most of the few vascular surgeons who train here eventually have to leave through brain drain, seeking opportunities abroad that our system cannot yet offer. Those who remain face an uphill battle against limited resources, lack of structured training, and poor recognition of the specialty’s importance. 

Still, I believe there is hope. Across low- and middle-income countries, subspecialty fellowships are beginning to emerge. They represent a realistic and promising path to strengthen the surgical workforce, especially in areas like vascular surgery where the need is undeniable. 

As a junior doctor, I don’t know exactly what my own training journey will look like. But I do know this: I want to dedicate myself fully to vascular surgery. I want to become good at it, not by being everything at once, but by being truly specialized. My hope is that Nepal will one day establish a dedicated fellowship in vascular surgery, so that I, and many others like me can find our flow.

Dr. Swechha Bhatt is a House Officer in Nepal with a strong interest in trauma and vascular surgery. Training in a low- and middle-income country, she has witnessed firsthand the real-world gaps in surgical care, which has fueled her passion for global surgery. A dedicated advocate for women in surgery, she works to challenge unconscious bias through surveys, campaigns, and mentorship. She has pioneered cost-effective simulation-based training models and led multiple workshops to expand access to hands-on education in resource-limited settings. Guided by her belief in “growing together,” she aspires to become a vascular surgeon and a global surgeon, committed to strengthening equitable and sustainable surgical systems worldwide