Mahabouba smelled foul, and villagers thought she had been cursed by God. They put her in a hut at the edge of the village and took off the door — so the hyenas would get her that night.

When the hyenas came, Mahabouba used a stick to fend them off. The next morning she set off crawling to get to an American missionary who lived more than 30 miles away. The missionary took her to the Addis Ababa Fistula Hospital, where she met Steven Arrowsmith, an American urologist from Grand Rapids, Mich.

Arrowsmith, now 54, has devoted his life to helping women and girls with fistulas, and he has almost certainly repaired more fistulas than any other American doctor. But Mahabouba’s case was unusually complicated — much of her tissue had rotted away — and she was in a deep depression.

“It was painful to be within three feet of her, because she was so miserable,” Arrowsmith recalled. She was also illiterate and did not understand the main Ethiopian language or the ways of cities.

He laughs now as he recalls the time his wife, Jan, a family physician, took Mahabouba to a prosthesis shop to get a leg brace so she could try walking again. Everybody else in the store had lost a leg or two from land mines, and Mahabouba grew panicky. Fearing that she was about to have her legs sawed off, she tried to flee.