Nyaya Health

Zach Silver, Tufts Class of 2012, serves as Executive Assistant at Nyaya Health.

At Nyaya Health, we believe in providing the utmost level of transparency so that you can know exactly what is going on behind the scenes of our work. We aim to maintain an “open source” approach that will provide you with access to our expenditures, operations protocols, and clinical outcomes. With this spirit in mind, we have created our DropBox Transparency page to allow you to read the very same files that our team reads. On our DropBox Transparency page, you will find all of the folders in our DropBox, along with screenshots of their content and links to their subfolders. While access to some areas may be prohibited due to personal privacy concerns, we want you to know exactly which folders are private and make sure that you have access to the ones that are not. Happy perusing!

Our current staff list in Nepal, with length of service, is provided below from our Accountant Chanakya Upadhyay.

Here are some basic facts:

• Total number of staff:  52
• New staff within the last 3 months: 18
• Number of staff serving more than one year: 23

We deeply thank all of our staff for their service and commitment to health and social justice in Achham.

The current organizational chart is here.

Mark Arnoldy, Nyaya Health’s Executive Director, guest-blogged for the Global Health Delivery Project on his experiences at the 2010 Global Health Effectiveness Program.

To me, the GHE Program is distinctive because of its focus on pragmatism, and the ability of the program’s diverse participants to lend insights and relevant real-world context that cannot be found in even the most insightful academic reviews. That is what happens when populations with experiences as varied as leading divisions of health ministries to nurses responsible for leading mass vaccination campaigns sit side by side and study the real world practice of organizations.

View the entire blog post here.

Mark and fellow students at the 2010 GHE graduation.

Duncan Maru, MD/PhD, is a co-founder of Nyaya Health.

We have written both here and on our blog about the challenges of adequate communication between hospitals in the Far West.  We both send and receive patients without any documentation or communication. This leads to missed diagnoses, repeated tests, untimely treatments. 

 To play our part in combating these communicative insufficiencies, we have recently developed a referral card that we fill out when we refer our patients.  This also provides a level of accountability for the use of our ambulance and enables us to better follow our patients after they have received advanced diagnostics and treatments from the outside.  

In the first two days of the card, we have referred a child with rheumatic heart disease, a woman with obstructed labor, and a child with uric aciduria. We will be experimenting how best to ensure return of the referral card.  Our new referral card is below:  

 (Nyaya team members: The PDF is available at \Dropbox\Nyaya Health\Nepal Programs
(TBD)\Clinical Programs\Referrals to Other Hospitals)

Duncan Maru, MD/PhD, is a co-founder of Nyaya Health.

We recently signed an agreement with Nepalgunj Medical College to improve the timeliness, safety, and effectiveness for the care received by patients from Bayalpata Hospital who require advanced treatment.  Typically, the system makes it such that patients who need referrals are left to fend for themselves, without clear mechanisms to ensure that follow-up and follow-through happens.  Care received by different providers is communicated via a chaotic array of non standardized patient cards that different providers have to leaf through to figure out what happened to the patient previously.  

With this agreement, Nepalgunj Medical College staff will receive our referral card, along with a request for payment subsidy and a form filled out detailing the patient’s socioeconomic status.  Our patients will qualify for subsidized care under Nepalgunj Medical’s charity care program, since most of them cannot afford the fees for their treatment.  The treating physicians there will fill out the card and return it with the patient to Bayalpata so that we can provide follow-up care effectively.  Additionally, Kanchan Gautam was with us and we toured their laboratory facilities which proved helpful in designing our laboratory expansion lay-out and procurement plans.

Drs. SK Konadia and MC Jain from Nepalgunj and Drs. Sheela Maru and Duncan Maru from Nyaya Health at Nepalgunj Medical College

Nyaya Health is honored to be mentioned on this Chronicle of Philanthropy blog highlighting the relationship between Good Ventures and GiveWell’s top-ranked charities. 

The Nyaya Health team is honored and proud that Agya Poudyal, our Director of Community Health, and Avishek Malla, a key implementing partner in our solar energy program, have both been featured in a documentary on young Nepalis that have chosen to return and serve their country. The documentary, entitled “This is Nepal,” is sponsored by the German Agency for International Cooperation, also known as GIZ Nepal, Centre for International Migration (CIM) and Development and the German Embassy. Both Agya and Avishek were present in Kathmandu in late January to attend a premiere screening and discussion of the documentary.

On Thursday, Nyaya Health was named amongst the top 10% of 3,508 organizations to advance to the semifinals in this year’s Echoing Green Fellowship competition. Co-Founder Duncan Maru and Executive Director Mark Arnoldy have applied for the Fellowship with intention to realize the organization’s plan to leverage innovative tools of transparency and open data to create and disseminate a new standard for health care delivery in rural Nepal.

Duncan Maru, MD/PhD, is a co-founder of Nyaya Health.

A middle-age woman presented to our hospital with abdominal pain and vomiting that was likely due to a viral infection.  Incidental to this, she described a mass on the right side of her groin that she said would occassionally come and go.  The mass was consistent with a femoral hernia, though certainly a large lymph node is also on the differential.

Her history, remainder of exam, and complete blood count were not suggestive of a chronic lymph node, however.  The mass was not reducible, and the ultrasound below, with the mass in the center of the image and the femoral artery/vein to the right, suggested a femoral hernia.  

Ultrasound of right groin region of the patient; the red areas are owing to lack of ultrasound gel currently at the hospital 

If our diagnosis is correct, she should receive surgery to prevent bowel strangulation.  Sadly, we are currently out of ultrasound gel and so are using hand washing gel for the ultrasound solution, and owing to the lack of this low-cost solution, our images are sub-optimal, for this patients and for our many obstetrical patients.  We have a procurement committee meeting tomorrow and hope that we can develop more robust supply chain systems.

She has agreed to go to Nepalgunj Medical College 14 hours away for evaluation by a surgeon.  The patient was very concerned about the cost.  Dr. Sizan Thapa, our outgoing medical director, is heading to Nepalgunj Medical, his alma mater, en route to Kathmandu, and counseled the patient and offered space in the jeep for the patient and her attendant.  At Nepalgunj Medical, Dr. Thapa will also be discussing possible avenues for collaboration, including a new referral system we are setting up to assist with patients such as these, the details of which are available here: http://db.tt/F3ABZuu1.