Nyaya Health

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.