UTH doctors puzzle

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UTH doctors puzzle

  • Medics looking to separate or not conjoined boys in operation

DOCTORS at the University Teaching Hospitals (UTH) are faced with another medical puzzle – how to allow two boys joined at the tummy and pelvis from birth to live separate lives.
The conjoined twins, Joseph and Joshua, were born five months ago at Chipata General Hospital in Eastern Province to a poor couple, Stella Ziwa and Charles Phiri, of Chief Nzamane’s area.
UTH has in the past few years successfully separated Siamese twins, with the most famous case being that of Mapalo and Bupe – two girls who were joined by the abdomen. The two girls are
now in the care of an orphanage in Kawambwa, Luapula Province.
According to Dr Amon Ngongola, who is one of only seven paediatric surgeons in the country, UTH has successfully separated three cases of Siamese twins after the BupeMapalo case in 2018.
But he said the latest case is unusual and poses a greater challenge to the doctors.
“Most of them are joined around the belly, but these ones the joining is far more complex because they are joined not just at the tummy but also on the pelvis. It’s not as
straightforward as a few others we have had,” he said.
“We have done other Siamese twins but this one is a lot more weighty because the intricacies of the surgery are a lot and the complications on this one are
much higher than what we had for Mapalo and others.”
Doctors are still assessing to see the best option for the infants, whether to separate or not.
“If after we have evaluated and think that the best course of action is to leave them the way they are, we have to look at how to improve their quality of life,” he said.
But Dr Ngongola is also concerned that the twins may face “tremendous stigma” if they grow up as one.
“That’s one of the biggest drivers to our desire to try and separate them,” he said.
However, separating the boys will mean that one of them will be deprived of a vital part of the lower body.
Dr Ngongola says the twins also share part of the liver and intestines, although he said that is not one of the doctors’ major worry.
However, Dr Ngongola could also not say for sure if there is any correlation between social status and the birth defect that results in Siamese twins.
“But it’s true that in our setting most of them will come from very remote areas. It’s possible that there could be a link,” he said.
And while the doctors ponder their next move, there is growing concern about the strain the situation is having on the 29-year-old mother, who has to take care of the infants single-handedly with only help from the nursing staff.
The biggest challenge for Stella is that the twins can only be held in one position without causing pain.
“She needs a lot of psychological help because she has to sit in one position for a very long time every day and she has done that for the past five months. Obviously that takes a toll on her,” Dr Ngongola said.
“It is easy to get depressed.”Stella also needs help with supplies for the twins. The couple has no financial support.Stella, who has three other children, said she did not know she was carrying twins until she was delivered of her babies through C-section.

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