Abul Bajandra has struggled with a rare disease for 20 years and he’s finally set to undergo surgery for his condition, which has transformed his hands and feet with gnarled, treelike growths.

Epidermodysplasia verruciformis is a genetic skin disorder that caused the Bangladeshi man to grow wart-like lesions on his limbs. Bajandra first noticed the growths on his hands at 10 years old, his doctor, Samanta Lal Sen, told CNN. He then tried to cut them off himself. It didn’t work, and the man now has one of the most severe cases of the disease that has ever been chronicled.

“This is one of the most rare cases of disease that I have seen in Bangladesh, even in the world,” said Lal Sen, the coordinator in charge of the surgery set to happen at Bangladesh’s Dhaka Medical Hospital.

Referred to as the “tree man” in Bangladesh, Bajandra was forced to quit his job as a rickshaw driver as his condition worsened. He now cannot hold a toothbrush or even a fork. His condition drew attention in his small village of Khulna, then attracted the interest of surgeons in Dhaka. They offered to perform the surgery for free.

“The surgery is a lengthy process and will involve many operations. The whole process can take up to six months,” Lal Sen said.