This was our first trip under the flag of the International Surgical Mission Support. In 2004 the team travel to the Himalayas amid civil war between the king and the Maoist. During our first day there was a threat from the Maoist against traveling and the team had to walk back and forth to the hospital several miles. The trip was done in association with the Nepalese organization Physicians for Social Responsibilities.  We have attempted to contact this group several times since our return without any success.  The general belief among our group is that this organization was either closed or its members jailed shortly after our mission.  The team was engaged in teaching the local surgeon the art of advanced laparoscopic surgery.