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| Sunday, 1 May 2005 |
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Features |  |
| News Business Features Editorial
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Too close for comfort by Lakmal Welabada Amidst talks of political upheavals, homicides, accidents, and strikes and hikes in various segments, Sri Lanka managed to record a medical anomaly with the birth of conjoined twins at the De Soyza Maternity Hospital, Colombo, last week.
The twin girls, joined at the stomach were born around noon on April 21 through a caesarian operation. They weighed (both together) just under 3.5 kgs (3 kgs and 410 gms to be precise). Though the birth of twins was anticipated with much joy, the birth itself has been cause for much sorrow, with Priyadarshani Deepa, the mother of the new born constantly sobbing over the physical condition of her daughters. "I was quite healthy and visited the clinic every month. I underwent a scanning test when I was three months pregnant, but nothing was told to me. It was detected that I was carrying twins only at the scanning done on March 30, the eighth month of the pregnancy. But still no one knew that my babies were conjoined until they were born," she sobs heartbrokenly. The date given for the delivery was May 20. But, as Priyadarshani developed high blood pressure, she was admitted to the De Soyza Hospital on April 18. And at noon on April 21, she delivered the twins via a caesarian operation. As she was under local anaesthesia, Priyadarshani was able to witness the birth of her babies.
When the surgeon pulled the bundle out and handed over to the nurse, she showed them to Priyadarshani and quickly rushed them to the Baby Room. "I knew they were twins. Although I only saw them for a moment at the delivery, I didn't know that they were physically connected to each other. I got to know about it only around 2.30 - 3.00 pm that day," she laments. After the surgery the mother was sent to the ICU, an usual procedure after a caesarian operation. When she got to know about her babies, she started to cry. "We did everything possible to console her. She was upset as she didn't see her babies properly and also as it was an unexpected blow to her," says Dr. (Mrs.) Mahesan, the ICU doctor who was present at that time. "Though he was really upset over the condition, the father of the babies was trying his best not to be emotional. As the babies were connected by their tummies we consoled the relations saying that the two can be separated easily. Though we were not sure about the real situation, we had to say so to calm them at that time," says the ICU doctor.
Dr. Indika Liyanage, Senior Registrar in Obstetrics and Gynaecology at the De Soyza Maternity Hospital was the surgeon of the caesarian operation. "It is very difficult to detect beforehand whether the twins are conjoined or not. Even in a scan, it won't be that clear as babies can be bundled together in the womb," he explains. "So when I was performing the surgery, first I delivered the head of one baby, and realised that I was delivering conjoined twins. So I quickly took every precaution that was necessary. Fortunately I had a similar experience before this during my Internship in 2000, when my Consultant Dr. Ranjith Almeida delivered conjoined twins at the Castle Maternity Hospital. I was his assistant. But, those twins expired just after delivery. In this instance, despite being joined at the stomach the mother and babies have been quite healthy," he remembers. Dr. Liyanage says that the newly born conjoined twins are on an intravenous fluid, especially prepared liquid that is similar to the body fluid. "We have to do so as we are not sure whether the bowels and digestive systems of the babies are functioning properly," he explains. Dr. Liyanage further says that the global incidence of conjoined twins is one in less than 100,000 births. "When the mother was transferred to the ward from the ICU for a few days, she cried continuously asking for her babies. As she was after a caesarian operation we sent her to the Baby Room in a wheelchair to see her offspring. This was the first time she had a good look at her new born daughters since their birth," says Mrs. Pushpa Dias, Midwifery qualified in-charge-nurse of Ward 16 at the De Soyza Maternity Hospital in which the mother of the conjoined twins was treated. The twins were sent to the Lady Ridgeway Children's Hospital, Colombo on April 25 while their mother, Priyadarshani was treated at the De Soyza Hospital. On the following evening, Priyadarshani was also transferred to Lady Ridgeway. A regular visitor is Tharaka, the father of the twins who visits his little daughters at the Surgical Intensive Care Unit on the seventh floor at the Ridgeway. None sees his anguish as he looks at his twin daughters lying in a tiny cubical. Kahandage Don Tharaka Sanjeewa and Heiyyanthuduwage Dona Priyadarshani Deepa, the young parents of the twins are residents at Mabima, Sapugaskanda. Tharaka(30) works as a cook at Hasthigiri Hotel, Pettah. Theirs was an arranged marriage with a perfect match of horoscopes. They entered into wedlock on August 5 last year with the blessings of their parents. The twins were a 'lucky' honeymoon happening, due to be born on May 20. "Our parents are still alive. I have a younger brother and a younger sister. My sister is married and has a child. My husband has an elder brother and a younger brother. My husband's Bappa (father's brother) has twin sons. Their's and our's are the only twins in our family," says Priyadarshani who turned 26 on April 25. She might have eagerly waited to celebrate her birthday with her new borns. Dr. R. Wimal Jayantha, Director of the Ridgeway Hospital was the officer-in-charge of the whole case from the day the conjoined twins were transferred to his hospital. Sunday Observer spoke with the Director while he was busy making arrangements to appoint a team of medical consultants for a panel discussion on the 'conjoined twins'. "We are doing our best to detect the possibilities of separating the twins. First we have to study and be hundred per cent sure about the actual anatomical position of the twins. Based on that, we have to decide whether we can go in for a surgery or not. Thirdly if we are going for a surgical separation, we have to decide whether we are going to do it here in Sri Lanka or abroad," Dr. Wimal Jayantha explains. The Director further says that he has a lot of confidence in his staff and consultants if the surgery can be done here. "The twins are in the Surgical ICU under the care of Dr. Ranjan Dias, Consultant Paediatric Surgeon. Apart from him we have five other consultants including Dr. P.M. Wijesuriya, Dr. B.A.D. Jayawardana, Dr. Ananda Lamahewa, Dr. Sooriyaarachchi and Dr. Sanjaya Abeygunasekara. "All these consultants are UK qualified, well experienced persons. Unless it is a fully complicated case which needs special types of investigation, treatment and follow-up care, I do not think we have to seek foreign consultancy in this matter," he says.Dr. Wimal Jayantha also emphasises that performing the surgery to separate the twins in Singapore would cost about three to four million rupees, and much more than that if done in UK or the USA, but fairly less in India. "And if we have to send the twins abroad then we may have to seek assistance from the public as I do not think the government could sponsor the case alone," he says. "We hope the twins are not sharing the same vital organs such as the heart, liver and main blood vessels, because then it will not be complicated. Whatever the case, they should be at least six months to one year old to face such a major surgery," he stresses. The Director further says that during his ten years of service at the Lady Ridgeway Children's Hospital he had come across three conjoined cases. "The first case occurred in 1996. The babies were to be taken to America for an operation, but died the day before the flight. "The second incident is not much clear in my memory. But the third set of conjoined babies lived upto three months," he recalls. The newest set of twins are in good health, but Dr.Wimal Jayantha says to keep the fingers crossed for good luck and better health.
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