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Indian doctors mull separation of 10-year-old conjoined twins
NEW DELHI -- Conjoined twins Saba and Farah have never enjoyed a normal life. Joined at the head for 10 years, they rarely leave home for fear of being stared at, and one of their few joys is watching famous Bollywood actor Salman Khan on television.
But Indian doctors are hoping to change that by separating them in an operation never performed in the South Asian nation. A decision on whether to go ahead with the risky surgery is expected within weeks. Saba and Farah have for 10 years shared one set of kidneys, a common artery that carries blood to their hearts and a common blood drainage vessel in the brain. Their family, in the impoverished Indian state of Bihar, never thought of separating them, because such an operation had never before been performed in India, nor did they have the money to send them abroad. By Rajesh Kumar, Section Health Posted on Mon Sep 12, 2005 at 01:46:51 AM EST
But all that changed suddenly last month after the girls' father, who runs a small restaurant, told reporters he was hoping for "a miracle" to separate his daughters.
When the news, and a photo of the girls, appeared in newspapers in the Middle East, Abu Dhabi's Crown Prince Sheik Mohammed bin Zayed Al Nahyan offered to pay for the surgery. His aides contacted Indraprastha Apollo Hospital in New Delhi, one of the best in the country, and the doctors there agreed, pending feasibility tests. "We want to do it not because it is an interesting medical case, but these are two beautiful girls who have lived extraordinary lives," said Anne Marie Moncure, the hospital's managing director. A 40-plus team of doctors at the hospital are carrying out various tests and consultations to determine whether such surgery is possible, Moncure said. They are also consulting with overseas experts such as Dr. Benjamin Carson at the U.S.-based Johns Hopkins Children's Center, who has led surgeons in four such operations at the Baltimore-based center, where six sets of conjoined twins have been separated since 1982. Doctors at a Singapore hospital who successfully carried out a similar surgery on Nepalese twins four years ago are also being consulted, said neurologist Mukul Verma, who is examining the girls. A major concern for doctors is separating the brain circulatory system. Because the girls share a major blood drainage vessel in the brain, the surgical team may need to graft blood vessels from other parts of their bodies to give them individual drainage vessels, the doctors said. An added complication is that one of the girls, Farah, has two kidneys while the other, Saba, has none. "If it is decided to separate them, we will take one of Farah's kidneys and transplant it for Saba," said nephrology expert Vijay Kher. Although their brains are somewhat merged, the girls haven't suffered any neurological damage, the doctors said. And they are developing into very individual characters. Saba wants to be a doctor when she grows up while Farah says she would like to become a teacher. "They like to play carom and watch popular Bollywood actor Salman Khan on television," Moncure said, referring to an Indian version of billiards. "They don't go to school, because they don't like going out, because they don't like to be stared at." If doctors agree to proceed with the operation, it would take a few months to prepare for the actual surgery. It wasn't immediately clear how much the surgery would cost, although the crown prince of Abu Dhabi has paid for all expenses since the twins arrived at the hospital last week. "It would be in the millions of dollars, but we haven't got to costs yet," Moncure said. Most conjoined twins -- one in 2 million births -- are born dead. Out of those born alive, some 60 percent die within hours or days after the birth. The number for those surviving more than a year worldwide is believed to be between 10 and 20. The instances of doctors operating on conjoined twins are rare, because the surgery requires extremely sophisticated technology and medical knowledge available at very few hospitals across the world.Moncure said if successful, the surgery would be a huge boost to the Apollo Hospital and other Indian hospitals that are trying to attract overseas patients. "This surgery would reinforce India's growing reputation as a country of very talented doctors," she said. Although hospitals in Bombay, Delhi and Bangalore have received patients from neighboring countries and the Middle East since the 1970s, Americans and Europeans have only recently started to trickle in, fleeing staggering costs and long waits at home. Moncure said Apollo has lately seen a rush of American and British patients after it won accreditation from the U.S.-based Joint Commission International, which sets global benchmarks for health care provided by hospitals across the world. Many patients come to India because they don't have health insurance at home, while others don't want to wait months for specialized surgery. The biggest demand is for orthopedic surgery, followed by plastic surgery, infertility treatment and cardiology. (AP)
September 12, 2005
Indian doctors mull separation of 10-year-old conjoined twins | 0 comments (0 topical, 0 hidden)
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