For the last 14 years I have been part of a team of surgeons and nurses traveling to Vilnius University Childrens Hospital in Vilnius, Lithuania.   Each years trip combines clinics to evaluate preoperative as well as long term post operative children, 4 or 5 days of pediatric hand surgery as well as lectures to hospital staff as well as participating in meetings of the Lithuanian Society for Surgery of the Hand.  Over the years of this project we have witnessed tremendous upgrades of physical facilities accompanied by great strides in the development of hand surgery expertise in Lithuania.