Chandmati Pasi is, if nothing else, candid. She answers inquiries about her life with a measure of directness that is unusual in her community. Ask her how many children she has borne, and without even the suggestion of emotion she will tell you of the four children that have survived and the three that have died—one at birth, one within eight days, and another within five months. Prompted about her medical condition, Chandmati will just as matter of factly tell you about the day she felt her uterus prolapse.

Chandmati Pasi, a poor farmer from Rupandehi District, Southern Nepal, has suffered from uterine prolapse for eighteen years. She has accepted her condition and does not expect that she will ever be able to afford the surgery to correct it.

Chandmati was out collecting wood just fifteen days after the birth of her last child when it happened. It was a rainy day and the roads were slick with mud, causing Chandmati to slip. As she fell she experienced a sudden pain and the sensation of something dropping in her lower abdomen. Despite the pain, Chandmati had more work to do. With the same sort of un-questioning attitude with which she tells this story, Chandmati stood back up, adjusted the load of wood that was balanced on her head, and returned to her village to continue her day’s work.

Eighteen years have passed since Chandmati first felt her uterus fall. For eighteen years she has suffered through pain, fever, difficulty walking and an inability to control her bladder. Sometimes she has to stay squatting in a field for up to an hour and a half before she can overcome the pain that it takes to urinate. Eating and drinking also cause her severe pain, so she has reduced her food and water intake, despite warnings from the local community health worker that she is cutting short her own life.

For Chandmati, treatment for uterine prolapse is not a realistic financial possibility. Unwilling to tell her husband about her condition at first, Chandmati turned to her mother-in-law, who helped her collect some money from friends and relatives for medical attention. Chandmati took this money to the local health post, where she was prescribed medicine that would cure a related infection, but would not treat her prolapse. She took the medicine for one week, with no improvement.

Years passed and Chandmati’s condition only worsened. At one point Chandmati consulted a local village doctor, who told her that her condition could be cured with six injections. Chandmati saved 100 rupees for the first injection, but after that was unable to pay for the remaining five. Chandmati has simply accepted the improbability of treatment and continued on with her life, cutting grass in the fields, collecting wood from the forest, and raising her surviving children.

Eighteen years after her first fall, Chandmati is undoubtedly now experiencing an advanced stage of prolapse that can only be treated by hysterectomy. For this surgery, Chandmati would have to travel to the nearest major town and then pay at least 5,000 rupees to have the surgery performed. Chandmati says she cannot even afford to make the journey. “How can I pay for treatment?” she asks. “If someone can pay for my treatment, then I will go for surgery. Otherwise, I cannot,” she says, in her characteristically blunt manner. “I am a farmer. I have a family to take care of.”