TRINIDAD, Colo. – is becoming a beacon for victims of female genital mutilation.
Dr. Marci Bowers has performed about two dozen reconstructive surgeries on mostly African born women victimized as children by the culturally driven practice of female circumcision. Bowers is believed to be one of the few U.S. doctors performing the operation.
Bowers, who underwent a gender reassignment operation in the 1990s at age 40, said she relates to what her mutilation patients describe as a loss of identity, of not feeling whole.
"It took me so long to get there in my own life. I know what the feeling is like, seeking my own identity," she said.
Wearing a blue-and-white striped shirt, dark blue pants and sneakers to her pre-surgery exam, Massah asked that her full name not be used because she hasn't told most friends and even family that she was having the surgery, or that she was circumcised as a girl in Africa.
She paid a $1,700 hospital fee, plus lodging and travel expenses for the surgery last month.
"I will spend my whole life savings," she said, "even if it's for one minute of feeling complete."
The World Health Organization estimates 100 million to 140 million girls and women worldwide have been circumcised.
Cultural, religious and social factors have helped keep the practice alive among those who believe it will reduce promiscuity and take away sexual pleasure or desire. The World Health Assembly passed a resolution in 2008 urging an end to the custom.
The restorative surgery practice in this town of 9,500 people near the New Mexico border began in early 2009.
Last month, at a guest house a short drive from Bowers' office, Massah and six other patients talked late into the night, sharing stories that they'd found difficult to voice even with best friends. All requested not to be identified.
One 37-year-old woman from Richmond, Va., was circumcised as an infant in Nigeria and realized in college during a biology class that she didn't look like her textbook diagrams. She said she would still like to ask her mother why.
"Why did you allow it to happen? What were you trying to prevent?"
Massah said she was circumcised at age 11 by a village woman. She was with about a half dozen of her sisters and cousins.
She was placed before the woman and was held down before being cut with what she thinks was a razor. She still remembers her screams.
"Nightmarish," she said.
She has felt ashamed, incomplete and apprehensive toward sex, she said.
"It's embarrassing going for Pap smears," Massah said haltingly, trying not to cry. "Just the look on people's faces."
She said she was hoping for "wholeness" from the surgery. A week into her recovery, she said she felt "ecstatic."
"Some people get another chance in life through organ transplant, but for me, this is it," she said.
Bowers learned her techniques for operating on FGM victims with Dr. Pierre Foldes, who performs the procedure in France.
Typically, patients have not had the entire clitoris removed, Bowers said, and the surgery exposes what remains, uses remaining tissue to reconstruct labia that may have been cut away, and clears scar tissue.
She said the surgery typically results in improvement in sensation as well as cosmetic benefits.
Bowers hopes to form a teaching program so other doctors can serve FGM victims.
"Somewhere, at some point, women have got to hold hands and say, 'No, no more. We're not going to do this anymore,'" she said.
Bowers' patients pay their own hospital fees and travel and lodging expenses, unless an insurer agrees to cover the hospital fee. Bowers donates her services.
Just how long that will continue here is uncertain. Bowers has announced plans to move to California this fall, and Mt. San Rafael Hospital where she operates says it has no immediate plans to add a new gender reassignment surgeon. That would be a big change for Trinidad, where Bowers' mentor, the late Dr. Stanley Biber, performed more than 5,000 sex change surgeries over more than 30 years.
Attitudes toward female circumcision are changing, the women patients said.
But, said Massah, "It's changing, but too slow. It's going to take a lot of generations."
Iman, a mother from the Twin Cities area in Minnesota who was circumcised, is grateful for Bowers and the chance to talk with other patients who underwent FGM.
"I left all that baggage at the guest house, all the things that tormented me," she said. "Imagine dealing with your worst demons and then meeting six other people who are dealing with the exact same issues you are. Then you get to leave all your baggage there, with no judgment."
Unlike other women who were blindfolded and cut in village ceremonies, with drumming and singing in the background, Iman was excised at age 12 in Kenya, in a doctor's office.
She had localized anesthesia. "I remember everything," she said. "My mom was there. I don't blame her because she did what was done for her. It was a rite of passage."
Later, she was taken to her grandmother, who checked whether the doctor had done a good job, she said.
After her grandmother died, her mother didn't take her three younger sisters to be circumcised. "I give her credit for that," she said. "It stopped with me."