By Caroline Rwenji
KENYA: After a week’s anticipation on the fate of the conjoined twins born last weekend, specialists at the Kenyatta National Hospital (KNH) have decided not to separate them surgically.
The boys delivered at the Rift Valley Provincial General Hospital to Evelyn Omodho, 27, are identical twins. Surgery at this stage, the specialists said, is not possible and more time is required for growth of the body and its organs.
The Siamese twins lay in their incubator, one asleep and the other staring at lights oblivious of their situation as curious onlookers watch. Nurses are on standby to attend to them.
After extensive tests and scans carried out throughout the week, the Siamese twins were found to share kidneys, a liver, colon and bladder.
They also share a ribcage, abdomen, male genitalia and legs. Each twin, however, has his own heart with single blood circulation.
KNH Chief Executive Richard Lesiyampe said one of the hearts is fully functional, while the other is incomplete.
The boys also have separate small intestines that merge to join the large intestines in the abdomen. Their distraught mother declined to talk to journalists and sought privacy in the company of her husband.
Receiving counselling
Mr Lesiyampe nevertheless assured she is also receiving counselling, and medical attention to help heal her caesarean wound.
“The mother is recuperating well and the hospital will continue with counselling because under the circumstances she may go into shock.
She also has high expectations that the twins will be separated and be normal,” the hospital’s chief executive explained.
The hospital is providing primary health care as required and further tests. They assured the family they would prepare them to cope with the current situation as they prepare them for possible future challenges.
Dr Fred Kambuni, a consultant paediatric surgeon, who was among the key team probing the conjoined twins condition, said separation is not always the way forward.
The situation, he said, is critical, with 75 per cent of Siamese twins failing to survive as the “condition is not compatible with life settings”.
He added: “One or two conjoined twins are delivered each year and some do not survive the first couple of years.
The hospital can, however, boast of four successful separations where the children are still alive, with ages up to 20 years.
The last separation, he said, was done to two conjoined girls now in good health and living in America.
The twin girls were separated at three years old after their organs had developed well.
“Separation is possible but in some situations it is not a must. In this case the twins will end up with a disability,” he said.
He noted it would take about a year before the issue of surgical separation is considered.
Another consultant paediatric surgeon, Dr Josephat Njiru noted the issue of sacrificing one twin to save the other would raise ethical and religious issues.
Some twins, he added, refuse to be separated after growing up, as they prefer to live together as they were born.
Conjoined twins are genetically identical and are therefore of the same sex. They develop from the same fertilised egg that does not fully separate after fertilisation.
A developing embryo splits into identical twins during the first few weeks after conception, but stops before the process is complete. The partially separated egg then develops into a conjoined foetus.
Rare occurrence
Conjoined twins are more prevalent in Asia and Africa, despite being rare. They occur once in every 400, 000 live births.
The last time KNH was called for a similar task was in April 2011 when Mrs Mwaka Chaka’s conjoined babies were airlifted from Coast Provincial General Hospital to the referral facility.
They however died three days later while doctors were deliberating on the best cause of action.
Explaining what happened then, Dr Hezra Opere, said the children died while waiting to be taken to the theatre, where doctors wanted to create an anal opening because they did not have one.
