Inside Unimaid’s Breakthrough with Conjoined Twins Surgery

Until penultimate Monday, 7th March, 2011, I have never been close to the operation theatre of any hospital. When I entered on that fateful day, I lost my   balance and it took me several minutes to regain composure. The climax of my confusion was when I saw how doctors were using knives, scissors, needles among […]

Until penultimate Monday, 7th March, 2011, I have never been close to the operation theatre of any hospital. When I entered on that fateful day, I lost my   balance and it took me several minutes to regain composure.

The climax of my confusion was when I saw how doctors were using knives, scissors, needles among others, cutting, fixing and stitching the fragile bodies of a set of conjoined twins with utmost precision.

The first few pictures I took were blurred, because I was jittery and shocked to the marrow. My fingers, usually so active on my newsgathering missions, could not press the camera shutter as expected.

The whole adventure started when I received a call from a colleague who told me that around 8am in the morning, on that day, an unusual operation will be carried out by a team of over twenty Nigerian medical consultants and doctors at the University of Maiduguri Teaching Hospital (UMTH), in order to relieve the trauma of a set of twelve month old conjoined twins.

Immediately I heard the news, I made up my mind to go to the scene, and   went together with Bilkisu Babangida (BBC) and Inuwa Baba (NAN).

At the time we arrived the hospital, the “complex” separation of the conjoined twins had gone far, and one of the surgeons, Dr Yunusa Ali came out to the reception of the theatre room, and gave us a warm welcome.

We interviewed the parents of the twins.  Isa Hassan (30)? a farmer and his wife Binta Isa (25)? Full time house, all from Gaddaba village of Ningi local government area of Bauchi State. They were in a subdued mood anxiously waiting to hear something from the theatre .

“I am sure you would like to enter the theatre and see what is going on,” Dr Yunusa remarked. Before we said “yes” he took us to his office, and gave us outfits to enter the operating room.

We suddenly looked like “doctors” after putting on the surgical gowns similar to the ones they wore, including caps and shoe covers, which were allsterilized.

What I saw at the theatre room was phenomenal.  Located upstairs in the hospital, the room was spacious, very clean, and well-lit with overhead surgical lamps, with viewing screens and monitors.

There were no windows in the room, but the temperature. I saw special air handlers that filter the air and keep the room slightly pressurized, in relation to the outside.

The electricity has backup systems in case of black-out, and the edifice has wall device to regulate oxygen and anesthesia gases.

In addition, the room has operating tables, anesthesia cart, storage facility for common surgical supplies, and containers for disposables.

Initially, all the doctors had concentrated on the conjoined twins with their piercing instruments, working together with commitment, respect, dedication and of patriotism.

After many hours of cutting and mending, the hitherto “one body with two souls” became two kids with two lives. Soon, the doctors split, with one set curiously mending, stitching and adjusting Hassan on one bed, and the other set of doctors took Hussaini to another bed for the same purpose.

I saw happiness in the eyes of all the doctors who carried out the rare operation, as we captured them with our camera lenses, while they were tidying up the twins after the twelve hours of surgery.

Initially, there were rumours in the town that only one of the twins would survive because of the complexity of the situation.But after meticulous team work and endless prayers from well-wishers, the process turned out to be a huge success.Probably that was why all the doctors were elated, including dozens of medical students who watched the “miracle” via a television.

“We have succeeded in separating the two male conjoined twins,” the lead surgeon, Dr Auwal Abubakar said to us.

According to him, “in medical terms, we call their situation iskiophagus (joined at the pelvis). This type of conjunction is the most complex, because their lives were conjoined. Both of them have a small intestine, but shared one single large intestine,” Dr Abubakar said.

“We are grateful to God for making this possible…we are really grateful,” he said, admitting that the credit goes to many people.

According to him “This is not only pediatric surgery, it is a team work.  We had pre – surgery conferences together with other specialists, and discussed several investigations.  Apart from the liver that was conjoined, we had predicted almost all the abnormalities we found in the babies.

“Plastic and reconstructive surgeons played vital roles in reconstruction. Orthopedic surgeons helped us in separating the bones, theatre nurses also assisted in their own field. anathesialogist kept the babies alive and asleep   for close to thirteen hours. Our engineers in the hospital contributed immensely, because they placed us on generator and we didn’t have power failure,” Dr Auwal remaked.

He also gave credit to the medical students in the hospital. “About nine of them donated the blood facilityused for the operation.”

He said the operation took a long time because of the complications inherent in the systems of the babies. “We had to divide the large intestine into two… we also separated the intestine of the first baby, and joined it with the distal part of the bowel that goes into the anus. We then used the other half of the large intestine to construct an anus for the second baby. The process was really complicated,” the surgeon added.

He said as a result of the amendments made in the body of the twins, one of the three legs which they were delivered with,  had been severed and they would now have one leg each, and that one of them will grow up as a female.

“The two babies shared a single male external genital; as such we left the genital to one of them, because it is much easier to construct a female external genital than that of male. We have actually explained this to the parents, and we are going to raise one of the babies as a female,” he said.

Asked whether Hussain whose name will be changed to Hussaina (female) will give birth later in life, Dr Auwal said no. “She will function normally, but will not reproduce, because there are no reproductive organs, we have removed the testicles.”

He said the children will be kept in the Intensive Care Unit (ICU) for convalescence. “This is not the last procedure of the operation. We would have to do other things to tidy up other problems. We would much later go into the phase of rehabilitation, like getting them an artificial limb,” he said.

He said this is the second time that this type of operation was done in Nigeria. “The first was in Ibadan in 1972, but the conjoined twins had four legs. Many other pediatric centers in Zaria, Ibadan, Ife, Enugu and other places, had separated other types of conjoined twins, but this is the second time that this particular type has been done,” Dr Auwal revealed.

Asked about the factors responsible for giving birth to conjoined twins, Dr Auwal smiled. “Well, nobody will really tell you the cause of giving birth to conjoined twins, but the case is more common in Africa and Asia. Usually when you have twins, they split into two during their formation, but this one did not.”

“It was one of our students who was then in Ningi that saw the mother with the children, and recognized the deformity early. He immediately referred them to us and contacted me for discussion.

“We deliberately delayed the operation because the chance of survival if you separate them testicles early is 20 per cent and if done it at that (about one year old) they have 80 per cent chance of survival. This is because, if the conjoined twins are bigger, they would be able to tolerate the anesthesia better, and will stand post operation stress. Their tissues would be bigger, and you will be able to identify them much easier,” Dr Auwal said.

He praised the management of the hospital for giving all the desired support. “The management of UMTH had waived all the medical bills of the twins because of the status of the parents. There is no way they could foot the bills of the operation, including all the tests and examinations,” he said.

Dr Auwal said the efforts put in by all who took part in the operation will not be in vain. “We think they have good chances of survival  even though this is not the last of the procedures of the operation. We would have to do other things to tidy up other problems, because…there similar reported cases around the world and the children are doing very well,” he said.

He assured that if given the necessary support, doctors at the hospital have the potentials of doing even more complex operations in the future.

Binta, the mother of the twins, said the separation of the twins was the greatest thing that happened to her, and expressed gratitude to God. “When they were ‘gummed’ together, managing their life was very difficult. They had only one anus and you cannot tell who wants to excrete.

“Sometimes one will like to sleep and the other might not be in the mood to sleep.  I therefore have to cajole all of them to sleep…it was really an experience that I will live to remember,” she said.

Binta said she had given birth five times and had never gone to hospital for ante natal care. “I gave birth to all of them at home, through the help of local birth attendants,” she said.

Her husband, Isa, said he never thought his twins will have a semblance of normal life. “As a poor man, it was really, very tasking taking care of the twins. The only big support we got was from a former chairman of Ningi local government area, who gave us N50,000 to buy food for the kids,” he said.

Isa said since that time, there was no tangible financial assistance, and therefore called on well meaning Nigerians to help them.

“The parents really need help because they would remain in the hospital with the separated twins for some time, and you know what this means,” a nurse at UMTH observed.

For me, the adventure at the operation theatre was a worthwhile and unforgettable experience. We watched and took pictures as doctors pierced and stitched the babies. “Today, you too (journalists) are honorary doctors,” one of the surgeons humoured as we walked out of the operation theatre.

Two days after the operation, the same doctor called and joyfully remarked “The twins are in stable condition, we are pleased with what is happening,” he said.