Marima’s husband abandoned her and took another wife. Marima lay on a piece of plastic on the floor of her brother’s house, unable to move, utterly forlorn and alone, as family members scolded her for the constant stink.

“My sister-in-law said, ‘You’re too smelly; people don’t want to come to our house,’” Marima recalled, crying softly. She stopped eating solid food so that she would leak less feces, and for four months she lay unmoving on the floor and survived on tea and camel milk.

Marima dropped to just 55 pounds. She had bed sores on her buttocks and ulcers on her thighs and genitals from her constantly seeping urine. At 17, she waited to die.

“People said that God had cursed me,” Marima said. “I felt it was better to die than to have this problem.”

Then a family member took her to a branch of Hamlin Fistula Ethiopia, a nonprofit that treats fistulas. Today she is walking again, has recovered weight, and the hole with her rectum has been repaired. Dr. Fekade Ayenachew, the medical director, said he was still figuring out how best to deal with the leaking urine.

Fistulas used to be common in the West, and there was a fistula hospital in Manhattan on the site of what is now the Waldorf Astoria hotel. But once C-sections became available, they largely disappeared.

The way to prevent fistulas is also the way to prevent maternal deaths: Invest more in reproductive health care, including contraception and C-sections. This works: Ethiopia has cut its maternal mortality rate by more than half over 20 years and now aims to cut it in half again over just five years.