I met Mansala BK in the post-op ward of the Kohalpur Medical College, outside of Nepalgunj. She was one of three women curled up on consecutive beds, in an otherwise barren ward. The room was in the far wing of a dusty and quiet floor of the hospital and the ward was unattended.

Nine days ago Mansala underwent a successful hysterectomy to treat an advanced stage of uterine prolapse, from which she had been suffering for two years. It took Mansala three days to reach the hospital—one day in a bus and two days of walking. Although she suffers from back pain, heavy bleeding, and difficulty walking (because her uterus protrudes from her body), Mansala had no choice but to make the journey. She was identified and sponsored for the surgery by an NGO in her home district of Jazarkot in the Far West. But qualified teams of gynecologists, surgeons, and anesthetists at reputable hospitals are not available in the Far West, so NGOs have opted to send women like Mansala to Nepalgunj, where the hospital accepts patients from NGOs on a voucher system.

For Mansala, the history of her prolapse starts at the age of 15, when she married and moved into her husband’s home. At the time, Mansala’s mother-in-law was already deceased and her husband did not live with any other family members. Barely pubescent, Mansala became the sole person in charge of running and feeding a household.

For the last thirty-five years, Mansala has maintained a regular routine: awake at 4 am to cook, clean the house, feed the animals, and do the laundry until about 1 pm, when she finishes her housework and heads to the jungle and the fields to spend the rest of the day grazing the animals and hauling heavy loads of grass, wood, and water. For five days a month, when Mansala has her period, her routine varies slightly. This is because in the region where Mansala is from, cultural beliefs maintain that women are ritually impure at the time of menstruation. Women who are menstruating must therefore be secluded and isolated from contact with food and other humans, lest they anger or offend the gods.

The small huts where women from these communities go during their monthly periods are called chaupadi. They can vary greatly in size and condition. The worst of the chaupadis are not even tall enough for a person to stand, and barely big enough for a few to sleep close together. Often they are constructed of simple twigs and mud, and sometimes they double as animal sheds. In these cases women are made to eat and sleep in the company of their family’s livestock.

In many of these communities, menstruating women are seen as the source of curses, so they are confined to the shed on permanent quarantine until their periods are finished. They cannot cook, so they can only eat what their family serves them: often left-over rice, or perhaps a few roti.

The physical and social isolation that women experience in the chaupadi is not only psychologically traumatic, but can also be fatal. It is not uncommon for women to fall ill from snake bites while staying in the chaupadi. Recently, a 14 year old girl died of diarrhea while she was confined to a chaupadi; nobody would help her or take her for medical care, because they were afraid that if they touched a menstruating girl they too would become ritually impure.

Mansala’s situation was not as severe. She says that because she had no mother-in-law (and mothers-in-law are quite frequently the enforcers of traditional practices and violence against their daughters-in-law), her husband was lenient. Her chaupadi was attached to the house, and large enough to hold a bed that her husband built for her. She says that if she had had a mother-in-law, she would have had to sleep on the ground.

With the benefits of not having a mother-in-law, however, also came the hardships. Traditionally a menstruating woman must stay in the chaupadi all day and all night, so that she doesn’t risk spreading her impure status throughout the community. Mansala, however, did not even have what might be construed as the “luxury” of rest during her period. Because there were no other women in the household and her husband refused to make up for any of the chores other than cooking, Mansala was forced to work in the fields and the jungle during the days of her period and return to the chaupadi at night.

Mansala, like most women in her village, also gave birth in a chaupadi. Notions of female impurity correspond to menstruation and birth, so that women are thought to be polluted at the time of child delivery and for ten days after. Birth attendants are not available in her village and men do not attend to births (nor can they enter the chaupadi), so Mansala gave birth alone in her chaupadi. For ten days she remained alone in the room, where no one was allowed to visit or touch her or her newborn child. Her husband cooked for her, but Mansala was otherwise left to do her own washing, bathing, and childcare.

Despite the difficulties that Mansala faced in her home and in the chaupadi, she says that things were not so bad. Her husband may not have helped clean, work the fields, take care of their child, or go to the jungle, but at least he was able to cook for her when she was in the chaupadi. Now her husband is dead and her daughter is married and in another village.

After only ten days of recovery Mansala will make the journey back to Jazarkot; she expects that it will take her four days to walk through the hills to her home instead of three, because of the difficulty of walking after surgery. Mansala wipes tears from her eyes with the edge of her sari as she explains how her husband was supposed to accompany her for the surgery. Although she is now cured of the pain that she suffered from a prolapsed uterus, she has not been relieved of the hard work and isolation that she suffered for years at home and in the chaupadi. Now, as a poor widow in the remote Far West of Nepal, she will face an even greater burden of self-sufficiency and loneliness.