This case study is on the Emirates Friendship Hospital (EFH), a ship that provides medical services to the bottom of the pyramid (BOP) population residing in char areas of the Jamuna River in northern Bangladesh. Deprived of regular access to medical services, these people look forward to the arrival of the Jahaj, or ship, with a solution to their ailments. Despite being equipped with state of the art facilities and delivering services through a team of dedicated local and foreign doctors, the only money EFH charges its patients is about BDT 5 (USD 0.60), which is more of a fee to assure dignity of the individual rather than to ensure a revenue stream. Providing this service to the BOP population comes with its own unique set of challenges and EFH has, during the past decade, designed unique ways of providing service seamlessly. Despite success during the last ten years, EFH faces a unique set of challenges. The case offers students an opportunity to understand the strategies that need to be formulated to ensure the sustainability of a fully funded project, dependant on a dedicated workforce, and in an extremely remote area.