Rashmi Rekha Das, OP
The surgical procedure of separating the conjoined twins, Jaga and Kalia, was a tour-de-force and the doctors at AIIMS in New Delhi who undertook the daunting task deserve kudos. Sunday POST delves into the mysterious – and often sad – stories of conjoined twins who were ostracised and whose fate took a tragic turn quite unlike that of Jaga and Kalia’s
Imagine having a sibling constantly at your side, waking up every morning to find your sibling lying right next to you. Imagine having to do everything together, even sitting on the same chair or riding the same bicycle. Then, imagine that sibling being taken away from you. About one in every 70,000 to 100,000 people go through this on a regular basis. They are known as conjoined twins.
Conjoined twins are an incredibly rare and intriguing phenomenon. Births of conjoined twins are considered as rare occurrences in medical science. They are always identical and monoamniotic-monochorionic, (sharing the same amnion and chorion). Identical twins happen when one fertilised egg spontaneously splits into two identical halves. The connection between the twins’ bodies may range from fairly simple to very complex. Both children may have all the organs and other structures they need, or they may share vital organs, like their heart or other structures. Their bodies may be able to support both lives, or it may be hard for one or both to survive because of health problems.
So, treatment for each set of twins is unique. The successful separation of conjoined twins, Jaga-Kalia, has kindled hope for parents with doubts about the separation operation. With the condition of Jaga and Kalia getting better day by day, Sunday Post chronicles a few cases that have evoked curiosity for years.
The blessed one
The 27-month-old twins hailing from a poor family in Milipada village of Phiringia block in tribal-dominated Kandhamal district were admitted to AIIMS, New Delhi, July 13. The first phase of surgery to separate the twins was completed successfully August 29. In the almost 20- hour-long first phase, the doctors performed venous bypass to separate the veins shared by the babies that return blood to the heart from the brain. The second phase of operation was delayed as the health condition of Jaga was not satisfactory. Finally, the second phase operation was carried out October 25. The state government sanctioned Rs 1 crore from the Chief Minister’s Relief Fund for the treatment of the twins.
“I have never thought of seeing Jaga and Kalia separated. I never imagined that I would have this special moment in my life. It was like a dream come true, thanks to the support of the government and the people of the state,” said Bhuyan Kanhar, the elated father of the twins.
Kanhar is a farmer for whom it is difficult to provide a normal childhood to his kids who were conjoined at the head. “Jaga-Kalia took birth in the year 2015 in Cuttack. We, their parents, had approached doctors at SCB Medical College and Hospital asking them whether they could be separated and lead a normal childhood. They recommended us to go to Delhi for treatment. As I am a farmer, it was difficult for me to raise my kids. For much of their lives, I wondered if my boys would ever have an ordinary childhood. So, I sought the help of the state government to fund their surgical separation. I am grateful to the district administration and the state government for arranging the transportation and other costs involved. Both of my children are now able to crawl, thanks to the efforts of the state government,” he said.
“As of now Jaga’s health is better than Kalia’s. They will take another four months to recover completely. I hope things will all go well with the blessings of Lord Jagannath,” added the father.
The twin’s mother Puspanjali said: “I am sure both of my kids will get well soon.”
Assistant manager at Chief District Medical Officer of Kandhmal, Soumya Ranjan Samantray, who is currently posted at AIIMS in New Delhi by the Orissa government to keep a tab on the improvement of twins’ health condition, said Jaga is responding to doctors and his mother’s call, but Kalia will take time. Jaga has been taken off ventilator support. If he remains stable, he will be taken out of ICU soon.”
He added: “All the vital organs of Kalia are in good condition. He is on multiple drugs and under constant observation. He will remain in the ICU for eight to 10 more days.”
So far, Jaga-Kalia’s tale has been a happy one. But the same happy fate doesn’t befall all conjoined twins. A sad tale of twins in 19th century Orissa readily comes to mind. They were taken to Europe, made to entertain audiences and finally met their ultimate fate under mysterious circumstances. Worse still, the twins, named Radhika and Dudhika, were given secret burials. The story of the “Orissa Sisters”, as they were called, is indeed heartrending.
Jinxed
According to renowned historian and researcher Anil Dhir, the twins were born in 1888 to Khestra Nayak of Haopara village in Dhenkanal district. For the poor parents, the deformed kids were a liability. Moreover, the birth of the conjoined twins was seen by the superstitious villagers as a symbol of divine wrath. The family was ostracised by the community and, in sheer desperation, the father tried to forcefully separate them. However, some local officials prevented him and the local Mahima sadhus took them under their protection. It was they who named the girls Radhika and Dudhika.
Word about the freaks went around and was reported in the English press in 1892. London showman Captain Colman sent his agent to Orissa, who convinced the monks to hand over the twins for their better treatment. There is even proof that an Oriya lady, probably their aunt, accompanied the twins. They sailed for the Americas to take part in the Chicago Fair of 1893, after stopping for a week in London. The ‘British Medical Journal’ carried a report on the twins in its June 1893 issue, citing “the two little girls, nearly four years old, are apparently perfect in every respect, except that from the ensiform cartilage to the umbilicus they are united together”.
Dhir’s research reveals that the twin sisters were a big draw at the Chicago Fair and attracted the attention of P T Barnum of the famous Barnum and Bailey Circus. They twins were soon a part of the “The Greatest Show on Earth.” The sisters were shown on colourful posters and postcards as the “Orissa Twins” or “Hindu twins”, and were big crowd pullers wherever they went. There were stories about the twins in magazines and newspapers, which portrayed them as exceedingly pretty, charming and vivacious. Captain Colman treated the girls as an adoptive father and the girls were happy with each other. They learnt English and travelled all over Europe and the USA.
“In 1902, while in France, Dudhika developed tuberculosis. With the hope of saving Radhika, Dr Eugene Louis Doyen, the famous surgeon of France and a pioneer scientific film-maker, did the separation surgery February 9, 1902,” said Dhir.
“He filmed the twins’ surgery and showed is as “La Separation de Doodica-Radica”. Sections of Doyen’s film were part of the 1995 BBC documentary series “The Last Machine”. The operation was a failure as Dudhika died just seven hours after the surgery. Radhika too did not live long; she passed away after a few months. Dr Doyen’s operation stirred up a controversy in the medical fraternity of the time. Both the sisters were given secret burials in Paris. Nothing was known about them until Thierry Lefebvre, wrote about them in his 2004 book titled “Flesh and Celluloid: The surgical cinema of Dr Doyen”. Few in the state know of them, there are no archival accounts of the twins who had toured the world a good four years before Madhu Babu stepped ashore,” he said.
Hope for wellbeing
Should conjoined twins be surgically separated as separation is not only technically challenging it can also involve life and death decisions about whether one twin should be sacrificed in the hope of saving the other.
Tapan Dixit, an Ayush doctor, said: “As of now Jaga and Kalia are doing well. It was itself an achievement for us as the second phase operation was successful. Shading all negative thoughts, I hope they will lead a normal childhood.”
Hemlata Das, a doctor at the haematology department of SUM hospital, said: “I appreciate the efforts of the doctors who carried out the operation upon the conjoined twins. Usually parents don’t want to risk losing their children; so they think it is not such a terrible option to leave their twins joined because they believe their children are more able-bodied together than they would be apart. Often, one twin will die at the expense of the other. However, doctors took a risk to provide a normal childhood to the twins. If they can make one of them survive and lead an independent life, it will be a huge success in itself.”
Mamata Tripathy, gynaecologist, said: “Both the twins are in doing well following the second phase of surgery. We should all pray for their wellbeing.”
JOINED AT BIRTH
Erika and Eva Sandoval: Born on August 10, 2014, in California to Aida and Arturo Sandoval, they were joined at the lower chest and upper abdomen and shared a liver, bladder, two kidneys and three legs. They were successfully separated December 6-7, 2016 in California.
Acen and Apio Akello: Born on September 23, 2014, in Uganda, the twins were joined at the hip and pelvis. More than 30 medical specialists’ effort to separate the girls’ spinal cord was successful on September 3, 2015. The medical specialists used 3-D printing to create anatomies similar to the girls to prepare for the
surgery.
Carter and Conner Mirabal: Born on December 12, 2014, in Jacksonville, Florida, to Michelle Brantley and Bryan Mirabal, they were joined at the sternum and abdomen and shared a liver and part of their small intestines. On May 7, 2015 they underwent a surgery and separated.
Scarlett and Ximena Torres: Born on May 16, 2015, in Corpus Christi, Texas to Silvia Hernandez and Raul Torres, the twins were connected below the waist, sharing a colon and a bladder. Scarlett and Ximena were separated on April 12, 2016 during a 12-hour procedure.
Anias and Jadon McDonald: Born on September 9, 2015, In Chicago to Nicole and Christian McDonald, they were joined at the head. On October 13-14, 2016, they were successfully separated after 27 hours of surgery in New York.