Dr Prasanna Karki’s career outlook began in school when her chemistry teacher doubted her capability to pursue science; ironically, it fueled her determination instead of diminishing it. Today, Prasanna continues to break barriers as the only female licensed neurointerventional neurosurgeon in the country, regularly advocating for equal pay and recognition.
With a 90% success rate, Prasanna has been involved in over a thousand open brain surgeries, including a few spinal cases, one notably of her own mother. She started her career in 2015. She still vividly remembers her longest surgery of 18 hours. “I view my work not merely as a job, but as a form of meditation, where I am wholly focused on the intricacies of the human brain during surgery, it’s truly a world of its own. Time seems to bend in the operating room, with hours passing in moments, making even the longest surgeries feel brief and invigorating,” shares Prasanna.
As a woman in a highly demanding field that commands precision at all times, she aims to set an example and inspire young women to pursue careers in challenging specialties like neurosurgery and neuro intervention, where creativity and resilience are paramount.
In conversation with WOW’s Ankita Jain, Dr Prasanna talks about what drives her as a neurosurgeon, gender equality in surgery, major challenges and more. Excerpts:
Coming from a non-medical family, what made you choose neuroscience?
Growing up in a non-medical family, I was always captivated by the concept of surgery, often playfully recruiting my younger brother as a ‘patient’ for mock operations. My fascination with the complexities of human anatomy and the dynamics of the beating heart initially drew me towards cardiothoracic surgery. However, during medical school, I realised that merely diagnosing patients and then referring them for surgical interventions felt incomplete. This realisation led me to neurosurgery, a field where I could both diagnose and perform surgeries, offering a complete timeline of treatment.
The decision to specialise in neurosurgery was also fueled by my interest in understanding the brain’s intricate workings and its impact on every aspect of human behaviour from emotions and logical thinking to subconscious thoughts.
I am intrigued by the brain’s role in personality development and its vulnerability to various diseases. Additionally, I am interested in brain wellness and the preventative aspects of neurology, such as the influence of nutrition and stress on brain health. Neurosurgery is not just about treating the brain; it’s about exploring the enigmatic and subconscious facets of it, which continues to inspire and shape my career path.
What drives you today as a neurosurgeon?
My drive stems from the potential to profoundly improve the quality of life for my patients. Neurosurgery is more than just performing operations; it’s about embarking on a transformative journey with each patient, guiding them from despair to hope and towards recovery. The complexities of this field fuel my motivation to excel and deliver remarkable outcomes.
The relentless advancement in medical technology and surgical techniques keeps me continually learning and evolving. I strongly believe in innovation and technology and am very excited to see what AI will bring to the domain of brain health.
The gratitude expressed by my patients and their families after seeing their lives improve post-surgery is deeply gratifying and pushes me to expand the possibilities within neurosurgery.
Moreover, the immense support from my family and well-wishers constantly fuels my passion. Their encouragement is pivotal, keeping me steadfast and motivated through the challenges.
While men may start from zero, women unfortunately start from “negative fifty” in fields like surgery. Despite this, the landscape is changing, and I urge women to join professions where they can excel, be confident, and truly live to their full potential.
There are only six female neurosurgeons in the country currently. What leads to such a gender gap?
During my time in medical school, over half of the students were women, yet very few chose to pursue a specialty in surgery. This discrepancy often stems from societal conditioning that encourages women to lead dependent lives focused on family rather than careers involving significant challenges or breaking new ground.
Particularly in patriarchal societies, many women are dissuaded from entering fields that require them to trailblaze, partly due to cultural biases and lack of family support; not everyone is as fortunate as I have been with supportive parents.
The gender gap in neurosurgery mirrors broader societal stereotypes and barriers, which include misconceptions about the physical demands, the supposed impossibility of achieving work-life balance, and the hierarchical, competitive nature of surgical training. Attending both national and international neurosurgical conferences, I find it rare to encounter other women in this field. The challenges we face are manifold: breaking glass ceilings, training in male-dominated environments, handling professional egos, and gaining the trust of patients in a patriarchal society.
However, I am heartened to see a shift with more young female medical graduates showing interest in surgical specialties. They seem more open-minded, likely benefiting from stronger family support. Addressing the gender gap in surgery requires a comprehensive approach that includes encouraging young women from their school years, providing robust mentorship programs, and ensuring equitable opportunities and support within the medical community to thrive and advance.
It’s often said that while men may start from zero, women unfortunately start from “negative fifty” in fields like surgery. Despite this, the landscape is changing, and I urge women to join professions where they can excel, be confident, and truly live to their full potential.
As a female neurosurgeon and neuro interventionist from Nepal, I have faced numerous challenges shaped by a patriarchal society. My journey began in school when my chemistry teacher doubted my capability to pursue science, ironically, fueling my determination instead of diminishing it.
You are the only female licensed neurointerventional neurosurgeon in the country. How does neuro intervention help the patient?
Neuro intervention is a transformative field that addresses complex neurological conditions using minimally invasive techniques. Utilising advanced imaging technology, we guide tiny instruments such as catheters and wires (about 0.043 centimeters in diameter), through the vascular system (arteries). This approach enables us to treat aneurysms (abnormal ballooning of arteries in the brain), acute strokes (blood clot in arteries in the brain blocking blood flow), vascular malformations (veins and arteries entangled in the brain), remove / reduce the size of brain tumors, and open stenosed vessels (opening of narrowed arteries), among other critical conditions.
For patients, the benefits of neuro intervention are substantial, including reduced surgical risks, shorter hospital stays, and faster recovery times, allowing them to quickly return to their daily activities. This overall reduces the cost of the treatment. As the only female neurosurgeon specializing in this field in our country, I am deeply committed to advancing these technologies and methodologies, ensuring that more patients have access to these groundbreaking and affordable treatments especially in the context of Nepal where health insurance is still lacking.
I am also devoted to spreading awareness about brain stroke (lists #3 in Nepal for death), its urgency and the potential for reversal using neuro intervention. Time is critical in such emergencies; a delay beyond 4.5 hours from symptom onset significantly increases the risk of lifelong paralysis. My current focus is on educating the public and healthcare providers to expedite treatment, aiming to reverse the effects of stroke without the need for open brain surgery.
Could you walk us through some of the modern high-tech surgeries that you have performed in Nepal Mediciti Hospital?
At Mediciti, I have had the privilege of working with some of the most advanced surgical technologies throughout my eight-year neurosurgical career. My experience spans a variety of open brain surgeries, including those for trauma, tumors, aneurysms, and vascular malformations.
After completing my fellowship in neuro intervention in 2022 in Bangkok, I began performing non-invasive brain surgeries in Nepal. These procedures involve inserting catheters and wires through the small arteries in the hand or foot to access and treat brain vessels without the need for open surgery. This technique has enabled us to reverse paralysis, shrink brain tumors, and even insert medical glues into brain vessels, providing significant benefits to our patients.
These methods offer unprecedented precision and control, especially crucial in the delicate areas of the brain. We use intraoperative navigation technology, akin to a GPS based navigation for the brain, which provides exact locations and directions during surgery, significantly enhancing both safety and efficacy. Additionally, neuromonitoring devices help ensure we avoid vital nerves, and microscope-integrated indocyanine green allows us to trace blood vessels during operations, minimising the risk to critical brain structures and optimizing patient outcomes.
Each procedure is extensively tailored to the patient’s unique anatomy and condition, ranging from complex tumor resections to intricate vascular repairs.
What are the major challenges you have experienced in your journey so far?
As a female neurosurgeon and neuro interventionist from Nepal, I have faced numerous challenges shaped by a patriarchal society. My journey began in school when my chemistry teacher doubted my capability to pursue science, ironically, fueling my determination instead of diminishing it. This incident solidified my dream of becoming a surgeon and instilled in me a resolve to always support women, who are often undermined by their own gender, the opposite gender, and society at large. Despite these societal hurdles, my medical school experience was relatively smooth, buoyed by my unwavering commitment to enter the surgical field.
Interestingly, while approximately 60% of my medical school peers were female, very few have pursued careers in surgery, reflecting a broader issue of gender disparity in more specialised fields.
Upon returning to Nepal as a qualified neurosurgeon after completing my training in Japan, I was confronted with a significant salary gap between male and female surgeons, despite having equivalent qualifications. This disparity was discouraging, as financial independence is crucial for women’s empowerment. In response, I sought opportunities elsewhere, which proved challenging as I often encountered skepticism from people unaccustomed to female surgeons. Today, I continue to break barriers as the only female neurosurgeon in my team, regularly advocating for equal pay and recognition. I am very lucky to have my mentor and team support me; they are very liberal and progressive.
The introduction of non-invasive treatments in my practice has gradually helped in gaining the trust of patients and colleagues, showcasing the value of innovative approaches brought by younger doctors. Despite these advances, female doctors, apart from those in gynecology, still face significant professional challenges. I hope to make my journey a testament to resilience and the ongoing struggle for equality in the medical profession.
I recognise that overcoming the myriad challenges I face requires maintaining high professional standards, continuously updating my knowledge and skills, and actively participating in the global neurosurgical community. Building a supportive network and fostering a collaborative environment are also crucial aspects of my approach. By adhering to these principles, I aim to further advance my capabilities and contribute to the evolution of neurosurgery, while advocating for gender equality within the field.
Could you share the number of surgeries you have performed, and the longest one?
Since 2015, I have been involved in over a thousand open brain surgeries, including a few spinal cases; one notably on my own mother. These procedures have ranged from standard to highly complex, sometimes requiring a collaborative team effort and sometimes operating on my own. Since 2023, I have also undertaken more than 150 non-invasive neuro intervention cases.
Among the open surgeries, the most memorable was an 18-hour marathon to remove an arteriovenous malformation from a young woman. The success of this surgery, which involved meticulous planning and a team of specialists, was profoundly rewarding, especially seeing her walk back home. For non-invasive cases, which typically last between one-three hours, I wear heavy lead radiation protection gear and eyewear to shield against radiation hazards. It is a good workout wearing a five kg suit.
Success rates of your surgery…
As a neurosurgeon, I often encounter critical cases upon arrival, with outcomes heavily reliant on the initial consciousness scale. With advanced skills, state-of-the-art technology and teamwork, I have been fortunate to keep the success rate of the surgeries consistently above 90%. This success is not solely my own but a testament to the entire team at Mediciti, our cutting-edge facilities, and our dedication to patient-centered care.
Our approach is uniquely patient-oriented, offering both open and non-invasive surgical options. Frequently, non-invasive neuro intervention techniques are used prior to open surgery, enhancing outcomes through a comprehensive treatment strategy. Having a neuro interventionist on the neurosurgical team, as in my role, significantly benefits patient outcomes, demonstrating the importance of integrated, specialised care.
Going forward, what are the changes you anticipate, and what are the opportunities that you foresee?
The future of neurosurgery is on the brink of significant transformation, propelled by technological advancements in AI and machine learning. These innovations promise to revolutionize diagnostic and surgical precision. During my fellowship training in Thailand, we utilized AI software to diagnose brain stroke patients rapidly. This system alerted all medical staff via mobile devices and smartwatches as soon as stroke indications were detected, showcasing the practical benefits of AI in real-time medical response. Such technologies are not far from becoming mainstream. AI’s role in enhancing the diagnosis and treatment of patients is undeniably promising.
Further, neuro technologies like Neuralink and Synchron are in human trials, aiming to enable paralyzed individuals to regain functionality, which I hope will soon be available in Nepal.
I anticipate a shift towards personalised medicine, where treatments are tailored to individual genetic profiles, significantly improving outcomes. There is also an increasing awareness of the preventive aspects of health and longevity, which forecasts a bright future for both public health and neurosurgeons.
Now as fairly experienced neurosurgeon with an illustrated eight years history, what advise would you give to budding neurosurgeons?
Truly speaking, I don’t consider myself as an experienced neurosurgeon as there is still so much to learn. Based on my eight years of experience, I offer guidance to those new to this challenging yet amazingly rewarding field. Embrace lifelong learning as the cornerstone of your career. Neurosurgery continuously evolves with groundbreaking research, new techniques, and advancements in technology. Dedicate yourself to ongoing education through attending conferences, workshops, and continuous medical courses. Seize every learning opportunity from mentors and peers alike to stay at the cutting edge of the field and enhance your expertise.
Mentorship is vital. I recommend not rushing into independent practice. Spend at least five years post-graduation under the tutelage of seasoned mentors to refine your skills and develop the nuanced judgment that neurosurgery demands. Concurrently, focus on honing your skills over seeking early financial gains. Proficiency in innovative technologies and techniques will distinguish you and set the stage for your future success.
Maintain your personal health and fitness; neurosurgery requires both physical stamina and mental resilience. Long hours and complex cases are common, necessitating robust health and endurance. Prioritize proper nutrition, regular exercise, and adequate rest to sustain the high level of performance required in this profession.
Effective communication and teamwork are also crucial. Neurosurgery is inherently collaborative, involving a diverse team of healthcare professionals. Strengthen your communication skills to enhance teamwork and ensure optimal patient care. I also recommend pursuing fellowship training after five years of practice, which will further refine your skills and help you identify your super-specialty interests.
Above all, always prioritise your patients’ safety and well-being. This extends beyond surgical precision to include empathy, active listening, and responsiveness to the concerns of patients and their families. A compassionate approach can significantly impact patient outcomes and satisfaction.
Adhering to these principles will not only lay a solid foundation for a successful neurosurgical career but also allow you to make meaningful contributions to your patients’ lives.
Target based surgery linked to revenue leads to unethical practices and non-transparent work culture. Your comment.
At our facility, Nepal Mediciti, we practice a patient-first approach. As full-time neurosurgeons, we are not incentivised on a per-case basis, ensuring that our primary motivation is the patient’s health outcomes rather than profit. This ethos was instilled in me by my mentor at Mediciti, who has always prioritised patient outcomes – a philosophy that I continue to learn and uphold.
Our team is dedicated to providing round-the-clock care for acute neurosurgical emergencies, only advising surgery when it is absolutely necessary for the patient’s benefit. This reflects our commitment to ethical medical practice and transparency in patient care.
There is a common misconception that Nepal Mediciti is expensive and unaffordable, but this is not the case. We regularly serve patients from public hospitals at special rates and provide neuro intervention services through our collaborations. Our rates are comparable to other major private hospitals in Nepal. The perceived cost difference often stems from our use of the most advanced technologies in our operating rooms and intensive care units, which significantly enhance the quality of care we provide. This investment in technology is fundamental to our mission of delivering the best possible outcomes for our patients.
Do patients keep in touch post recovery?
It’s quite common for patients to stay in touch with their neurosurgeons after recovery. The nature of this contact varies, ranging from formal follow-up appointments to more personal updates on recovery progress. Even patients from remote areas, though harder to maintain regular contact with, often return after a few years, bringing joy as they resume their normal lives. This ongoing communication is invaluable as it provides essential feedback that helps both the patient and surgeon monitor long-term recovery. Post-neurosurgery, patients typically require sustained therapy, medications, and regular blood work.
Moreover, I offer virtual consultations to accommodate patients who are geographically distant or residing outside Nepal for work. They can reach out via platforms like Hamro Patro, WhatsApp, and even LinkedIn. Being able to provide support and see their progress, no matter where they are, is incredibly rewarding and a vital part of my commitment to their long-term health and well-being.
Knives, needles and scalpels; how do you view this relationship?
As a female neurosurgeon and neuro interventionist, my relationship with knives, needles, scalpels, catheters, and wires is one of profound respect and intricate familiarity. These tools, while seemingly simple, serve as extensions of my own hands within the sterile environment of the operating theater. They are the instruments through which I navigate the complex terrains of the human brain, its vessels, and the spine, each move demanding precision and delicacy.
In neurosurgery, every incision with a scalpel must be meticulously planned. There is little room for error; the stakes are high, as each operation offers no second chances. This requires not just technical skill but a steady hand and nerves of steel. In the realm of neuro intervention, I wield long needles, catheters, and wires to access and treat the brain and neck vessels. This technique allows me to manage and prevent life-threatening conditions without the need for open surgery, highlighting the advancements and capabilities of modern medical interventions.
These tools not only facilitate the physical aspects of surgery but also empower me as a woman in this high-stakes field to challenge norms and demonstrate that skill in surgery transcends gender boundaries.
On a lighter note, I occasionally swap surgical tools for kitchen knives, although my culinary skills might not be as refined – perhaps a predictable revelation, considering my professional focus leaves little room for culinary adventures!
Besides neurosurgery, what interests you?
Outside of the operating room, my interests extend to longevity, brain health, and age-reversal medicine. My family and friends have greatly benefited from my personalised recommendations and wellness rituals. I believe that the root causes of many diseases, including brain strokes and other complex neurological conditions, can often be traced back to nutritional deficiencies, hormonal imbalances, lifestyle and stress. My fascination also includes exploring age-reversal technologies and techniques, with a focus on maintaining a healthier life as we age.
When I am not at the hospital, my time is devoted to my seven-year-old son. I cherish our moments together, especially enjoying the sun, white sands, and the relaxing sounds of ocean waves. Therefore, I occasionally take a few days off to travel to beachside destinations with my family or friends, embracing the opportunity to recharge.
My culinary preferences are quite eclectic, ranging from authentic Thakali cuisine to my favorite Japanese and Thai dishes. I enjoy exploring and dining out, experiencing the rich variety of flavors that different cultures have to offer. Naturally, like many, I love to travel and explore new places, finding joy and relaxation in these experiences.
What do you look for in a partner?
First and foremost, I am happy and content with myself, but I believe that everyone needs companionship. For me, a mental connection is of utmost importance. As an introvert, I find it challenging to connect with someone unless there is a substantial intellectual bond. It’s essential that my partner is also happy and self-content, supporting our ability to remain independent individuals.
I value a partner who is open-minded, with a good sense of humor and a zest for adventure. We should each have our own space to pursue personal ambitions, yet provide immense support for one another. It’s important that a partner can also serve as a constructive critic, someone who challenges me to grow and evolve. This balance of independence and mutual support forms the foundation of a strong, fulfilling relationship.
What do you consider a red flag in a relationship?
When it comes to identifying red flags in a relationship, self-awareness and a clear understanding of your own needs can be incredibly helpful. Immediate red flags for me include a lack of personal discipline; often, this trait correlates with unreliability in various aspects of life. Additionally, consistent negative comments and judgments can foster a detrimental aura, stifling one’s ability to be themselves. Disrespect in social settings, a lack of firm personal stands, and opinions easily swayed by others are concerning traits that suggest a lack of integrity.
Moreover, – aggressive behavior, critical attitudes towards one’s dreams, or actions that undermine one’s confidence are serious red flags. A lack of caring nature, especially in a dynamic where one partner always gives without receiving similar affection or support, is unbalanced and unhealthy. It’s also wise to be wary of narcissistic personalities and pervasive pessimism, as these traits can significantly impair emotional health and relationship dynamics.
Any life lessons you would like to share with our readers?
While I am still on my journey of learning and growth, and may not see myself as wise enough to impart grand life lessons, I do have some insights based on my experiences, especially in health and wellness, that I’d like to share. It’s crucial to prioritise your health early on. Don’t wait until you achieve financial freedom to start caring for your well-being. Conditions like back pain, knee pain, or chronic diseases can significantly impede your ability to enjoy life’s successes when they finally arrive. The habits and diet you adopt in your twenties can impact your future health.
Life is singular, and it’s essential to pursue your dreams vigorously—dream big and find your purpose. No one else will start building your dream for you.
Companionship is more about the journey of life than the destination, so choose your partner wisely, as they are your companion through life’s ups and downs.
Especially for women, achieving financial independence is vital; it brings freedom, confidence, and self-respect, which in turn fosters respect from those around you.
On the topic of living a healthy lifestyle, something I am deeply passionate about given my focus on longevity and wellness, – I advise against frequent dining out and consuming ultra-processed foods. It’s important to reduce sugar intake, limit alcohol, and avoid smoking and vaping. Treat your body with respect – it’s not a trash can, so be mindful of what you put into it. Treat it well, and it will reciprocate with good health. These practices are fundamental to living a fulfilled and healthy life, guided by respect for one’s body and ambition for one’s dreams.
Being a mother, how difficult it is to balance between two very demanding roles?
Balancing motherhood with a demanding career in neurosurgery is indeed challenging, and even more challenging as a single mom, but I am blessed to have a strong support system in place. My mother plays a crucial role in this balance. She is exceptionally attentive with my son, providing care and support, which allows me to focus on my work without undue stress or guilt. I make a concerted effort to attend major events at my son’s school and significant dates of his life, although emergency cases sometimes require my urgent attention. My son understands the importance of my work, especially when it involves saving lives.
Treating this article as a time capsule, I hope to ask my son whether he feels differently about this when he is an adult.
We maintain open lines of communication, which helps me stay attuned to his emotional needs, ensuring that he feels cared for and understood despite my busy schedule. The most challenging times are during his long school vacations when taking extended leave is difficult. During these periods, I strive to spend as much quality time with him as possible.
This balancing act is never easy, but with the support of my family and the understanding from my son, I manage to fulfill both roles to the best of my ability.
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