Re: British Doctors Separate Twins Joined At Head
| |Twins Rital and Ritag Gaboura giggle at each other as they sit, propped up by large pillows, on a hospital cot.
Dressed in identical pink dresses dotted with brown hearts and warm woollen tights, they kick their little legs constantly with excitement.
Ritag, whose babbling fills the room, grabs the plastic lid of a feeding bottle from her sister's hands and begins examining it studiously.
Rital, the quieter of the two, watches her sister through brown eyes fringed with huge eyelashes. Indignant, she reaches out her chubby fists to try to win back her toy.
For those watching this scene on a private ward at Great Ormond Street Hospital for Children in London, it is impossible not to be touched.
Just six weeks ago, these girls were still joined at the head after being born with the rare and complex condition from which few children survive.
Doctors estimated their chances of being born and successfully separated without suffering any adverse effects at ten million to one.
They could not sit up or interact with one another and Ritag, who was pumping most of the blood around their bodies, was suffering from heart failure which threatened to end both of their lives.
That they are now thriving and expected to make a complete recovery appears nothing short of miraculous.
But it is thanks to the skill of British doctors and funding from a UK children's charity that the twins' future is now assured and, on Thursday, they celebrated their first birthday.
The only signs of their still-delicate condition are the white caps on their heads, which protect the holes at the top of their skulls where they were fused.
The sight of their daughters playing together is particularly poignant for their parents, Abdelmajeed and Enas Gaboura, who told The Mail on Sunday they have been overwhelmed by the generosity that has secured their family's future.
Abdelmajeed said: 'Just to see them interact is very emotional because there was a chance it might not have happened, that one or both of them might die.
'We have always seen them as two children in our hearts. They are now starting to understand there is someone else in their world, but they will need time to realise they are sisters.'
The girls' situation has been all the more frustrating for the couple because they work as doctors at home in Khartoum, capital of Sudan in North Africa.
Abdelmajeed, 31, is a specialist in obstetrics and gynaecology at the city's Soba University Hos¬pital. He met Enas, 27, while they were studying medicine at the University of Khartoum.
They married in January last year and the following month Enas was delighted to discover she was pregnant. Four months into the pregnancy, a scan revealed she was carrying twins –and the couple were told they could be conjoined.
An MRI scan the following day confirmed the diagnosis, but doctors could tell them only that their twins were joined at the head –not whether they could live.
Abdelmajeed said: 'We saw the scan. It was a terrible moment, terrible. We prayed for help and to find a solution. But our health system lacks expertise. No one seemed to know what to do. It was frustrating as doctors, knowing we couldn't help our children.'
Enas added: 'I was just crying and crying. I was very concerned about the safety of my children, and whether they would live through the pregnancy.'
Abdelmajeed found a specialist with experience in delivering conjoined twins and they were delivered by caesarean on September 22 last year at 36 weeks –nearly full-term –to give them the best chance of survival.
Enas nearly died in the operating theatre from blood loss and was taken away from her girls to recover. Abdelmajeed saw his girls first.
'It was very hard seeing them because their mother was not there with me,' he said. 'They were crying, and they wanted to be fed. Everyone was just standing there, staring at them.
'Obviously I felt great love for them, but it was still shocking. They were my beautiful girls but they had this join at the head. We had not really been warned how serious it could be. I felt as if I had brought something bad into the world which was not welcome.
'On the third day after being born, Enas could see them. I said she had to be strong. I expected her to cry but she had this huge smile on her face.'
Enas said: 'I had to be strong. I was their mother, they were my children. I saw beauty in them, but also I saw they were conjoined. But in a way, that made them beautiful to me, too.'
The couple saw many doctors but were told there was nothing that could be done for their girls. The couple took them home and struggled with day-to-day life. The girls fed and slept at different times and Ritag was particularly hard to feed, as her head was rotated to the side.
It was impossible to wind them, and bath times were a team effort. One twin would be placed on a pillow and raised above the water, while the other twin was lowered into the tub.
Abdelmajeed resolved to travel outside Sudan to find someone who would agree to a separation, and searched the internet obsessively. The couple knew it was a risk, and that the operation could kill one or both of their daughters. But it was a chance they wanted to take.
'It was a very frustrating time. But we didn't lose hope. If it took my whole life I would work towards this,' Abdelmajeed said.
Then he discovered that a previous set of Sudanese conjoined twins, Hassan and Hussein Salih, had been separated by a team of surgeons at Great Ormond Street Hospital in London.
He emailed the surgeon in November, who put them in touch with the charity Facing the World and one of its trustees, Dr David Dunaway, lead surgeon at Great Ormond Street's craniofacial unit.
The UK-based charity uses British craniofacial surgeons to help children with severe facial disfigurements from the world's poorest countries. Dr Dunaway agreed to discuss their case and the charity visited the family twice in Sudan to meet the girls and investigate the possibilities.
Flying them to the UK took months of negotiations because the twins could not be strapped into a commercial airliner. Finally, the Al Fayed Foundation paid for a private plane to bring them to London in April 2011.
Tests at Great Ormond Street revealed the girls were in real danger. Ritag was diagnosed with very high blood pressure.
She was supplying most of the blood to Rital and draining most of it back to her heart, putting her organs under enormous strain. The medical team rushed forward the separation from July to May.
The doctors decided to carry out the procedure in four stages to avoid either twin losing blood pressure, which could cause brain damage.
The first operation was a nine-hour procedure to separate their shared blood vessels and arteries while leaving their fused skull intact. Abdelmajeed said: 'We prepared ourselves to lose them.'
The second came the following week, to stop blood flowing between the girls and relieve the pressure on Ritag's heart.
In a further operation the surgeons inserted tissue-expanders designed to encourage the skin tissue to grow so there would be enough to cover their scalps.
The final, 13-hour operation to separate them took place on August 15. Abdelmajeed said: 'We knew they were going in as one, and coming out as two.'
Enas said: 'After the operation, they brought Rital out first. It was so miraculous. We had tried to imagine how we would cope with seeing two little girls rather than one. But in the end, it felt so natural. We are so happy.'
The girls, who are going back home to Sudan, will need further surgery to completely close their skulls but they are healthy sisters –an incredible result for their devoted parents and for the team of more than 20 specialists at Great Ormond Street.
Abdelmajeed said: 'What has happened does make us want to go back and make the health system better. I want to thank Allah and I want to thank the staff of Great Ormond Street and Facing the World, and our amazing friends.'