the limited availability of local treatment options. She was fortunate to be well educated and has completed high school after which she obtained a clerical position at a printing a press and was able to work daily, although with severe pain and deformities.

As she grew, she had noticed worsening left hip pain. The pain was located in the left groin and was present at rest, but exacerbated with motion. By the age of 29, the left hip was auto-fused to her pelvis resulting in no range of motion and a significant residual deformity. By this point, most of the symptoms were consistent with low back pain and degenerative disk disease due to increased loads experienced across the lumbosacral spine secondary to the auto-fusion of the left hip.

In July2012, at 33 years of age, the patient sought treatment from a rheumatologist in Nairobi and was told that she would need a total hip replacement (THR). However, a THR in Nairobi would cost \$7000, which was cost-prohibitive. Although discouraged, the patient tenaciously sought alternative routes for getting the appropriate treatment. By November 2012, due to the severe soft-tissue contracture (e.g., severe adduction contracture) surrounding the left hip, she was unable to urinate comfortably and was unable to have children because vaginal delivery would not be possible.

In November 2012, a rheumatology conference was held in Nairobi. A rheumatology colleague from one of the authors (NPS) home University in the United States attended the conference and met the patient. Intrigued by her story, she contacted the author upon her