When Dr Hillary Mabeya visited a condemned home in Eldoret, Kenya in 2009 and said, "This kitchen is going to be an operating room," he raised more than a few eyebrows.
Yet last month, Mabeya performed his thousandth surgical operation in that kitchen, which is now part of the Gynocare Fistula Centre. Mabeya is the only surgeon at Gynocare, a centre that performs the most fistula surgeries in Kenya, at no cost to the patient.
May 23 marks the second annual International Day to End Obstetric Fistula. Fistula is a tear in a woman's bladder or rectum that causes her to constantly leak urine or feces. At least two million women suffer from the condition, with 50,000 to 100,000 new cases occurring each year. The main causes are prolonged labour, botched Caesarean sections and sexual assault.
"I've heard women say to me: 'I wish I could have died in childbirth rather than live with this condition,'" Lindsey Pollaczek told Al Jazeera. Pollaczek works in Kenya as a senior programme manager for Direct Relief, an international organisation that supports Gynocare's work.
Most women with fistula live in remote areas, and are unaware that they can be healed with surgery. "They can't participate in family life, in social life, they can't go to church, no one will buy their vegetables," said Pollaczek. "Because they smell like urine, they become pariahs in their society, they lose a lot of self-respect, they feel like they've done something wrong to deserve this," she said of the devastating condition.
On a typical day last spring, Gynocare's patients included an 11-year-old raped by her neighbour, an 80-year-old woman who had fistula for over 60 years and a 19-year-old named Irene. Irene gave birth at age 13 and suffered from one of the worst fistulas Mabeya had ever seen.
Irene is from West Pokot, a remote region in western Kenya where, during medical school, Mabeya first dedicated his life to fixing fistulas. West Pokot has particularly high rates of fistula, due partly to the prevalence of child marriage and female genital mutilation, which raise the chances of complications in childbirth.
"These are very poor women who don't even [have enough] money to pay for transportation to surgery," Mabeya told Al Jazeera. "Their misery and the smell of their urine and stools - this touched me so much and I thought I should do something about it."
A man possessed
Mabeya became a man possessed, throwing himself into learning as much as he could about fistula. "During medical school I would sneak out of the house to do fistula surgeries. I almost failed my exams because I would skip school to do fistula surgeries," he said.
After medical school, Mabeya treated an infant who was raped during Kenya's 2009 post-election violence who developed fistula. He decided that Kenya needed a hospital dedicated exclusively to the condition. When a colleague told him about a dilapidated house for sale, he knew he had found his start. Funded entirely by his own savings, Mabeya delayed opening the hospital as he slowly collected enough scissors, sutures and needles to do surgery.
Once Gynocare was up and running, Mabeya visited West Pokot again and met Irene. She had been in labour for a week before she was brought to a hospital where she was informed that her child was dead. The doctor removed the foetus with crude forceps, further mangling Irene's already damaged reproductive and digestive systems.
Irene returned to her village leaking urine and feces. Her family and friends thought she was cursed, and her father refused to acknowledge her as his child. Like many women with fistula, she was chased away from home.
Other doctors have told me that I'm going to die poor because I've chosen to specialise in fistula surgery. You have to love what you're doing to do this job.
Mabeya couldn't operate on her in West Pokot, but told her that if she could make it to Eldoret, he'd do everything he could to help her. Irene walked for three days from her village to get to the nearest road. From there, she hitched a ride with three different cars, then took a bus, and then two motorcycle taxis to get to Gynocare.
Over the course of several years, Mabeya operated on Irene five times, her fistula improving incrementally with each surgery. But Irene was a classic example of what is often misunderstood about fistula patients: Treating the physical effects of the condition is only the beginning.
In addition to her physical pain, Irene was emotionally traumatised. Her ebullience and openness gave way to volatile mood swings. Mabeya wasn't the first person who tried to help her, but he was the only one who refused to give up on her. "You can't give up on Irene. She'll die,"said Caroline Mabeya, Dr Mabeya's wife and a social worker at Gynocare.
Gynocare sets itself apart as a medical facility by providing holistic care to patients that includes post-surgery counselling and job training. The Mabeyas enrolled Irene in their job training programme, where she learned to be a tailor. Caroline Mabeya counseled Irene, trying to help her cope with depression and her sense of isolation.
"I believe that I'll be okay someday. I'm thankful to God my life has changed. I hope I'll finish my training and make men's shirts and trousers. I think I'll be successful in life," Irene said last year after her fourth surgery.
In his house one evening last spring, Mabeya reached down and silenced his phone during dinner. "I have an old patient who calls twice a day. They get so attached," he said, shaking his head.
At his wife's insistence, Mabeya has cut back from operating seven days a week, but his personal and professional lives still flow freely together. They pay the school fees of particularly needy patients, and their home in Eldoret is full of poems and letters from patients whose lives he has changed.
"Other doctors have told me that I'm going to die poor because I've chosen to specialise in fistula surgery. You have to love what you're doing to do this job," he said.
This week, Mabeya proudly announced that Irene's most recent surgery was successful. She has returned to her village where she built a small house, and now supports herself as a tailor.
"I think fistula surgery is one of the most life-transforming surgeries that a woman can get. When they come [to Gynocare] they're downtrodden, they're feeling little self-worth," said Pollaczek.
"When they're able to be repaired and go home to their community dry for the first time, its absolutely life-transforming," said Pollaczek of the thousands of women like Irene whose lives have been restored.