What you need to know:
- Soon after birth, the babies were transferred to KNH which would be their home for the next two-and-a-half years.
- According to the doctors, this was necessary to allow the girls’ bodies to develop enough tissues to allow the complex surgery of separating them.
- Adding to her worries about the health of her babies was the cost of treatment. She was required to deposit Sh1 million for them to be admitted.
Blessing Kathure and Favour Karimi are oblivious of their surroundings as they chase each other across an open field near their home in Nairobi occasionally stopping to catch their breath before resuming their game.
Their mother, Carol Mukiri, watches in admiration, a hand to her chest. For her, seeing her daughters play is a dream come true. She regards them as walking miracles.
Seven years ago when Ms Mukiri went to St Theresa Kiirua Mission Hospital in Meru County, she expected to deliver normal healthy children but nothing could have prepared her for what she was to encounter.
Her girls were conjoined twins, born with their spine and abdomen fused together such that, although they had individual guts, they shared a spinal cord, rectum, anus, some muscles, subcutaneous tissue, and skin.
Doctors said the condition was a result of embryo cells not completely separating.
“I was in shock and scared. At first, I wondered if they were indeed my children. I eventually accepted [them], but it was hard,” she said, acknowledging her mother’s invaluable support during those first trying days.
She had a normal pregnancy with the usual challenges, such as morning sickness and swollen limbs. However, every hospital visit assured her that her babies were fine.
Soon after birth, the babies were admitted to the New Born Unit for a day before being transferred to Kenyatta National Hospital (KNH), which would be their home for the next two-and-a-half years.
According to the doctors, this was necessary to allow the girls’ bodies to develop enough tissues to allow the complex surgery of separating them.
Living in a hospital for years took a toll on Ms Mukiri’s mental health: “The process seemed to take ages. I was never at ease. All I wanted was to live a normal life with my daughters.”
However, she is quick to express her gratitude to the team at KNH, who, she said was helpful.
Adding to her worries about the health of her babies was the cost of treatment. She was required to deposit Sh1 million for them to be admitted.
This looked like an uphill task for her, an unemployed young mother depending on menial jobs to put food on the table.
“I was getting desperate but I did not have the financial ability to have them treated,” she said. Luckily, KNH came to the rescue and did the operation for free.
Then there was the daily stress of looking after the girls. Breastfeeding them and changing their diapers was overwhelming.
“I would hold them against my chest and weep … but I made a desperate prayer to God to allow them to live. I am grateful for this miracle because I could not have lived without them,” she said.
Meanwhile, the girls were growing up. Their biggest challenge was movement as each one wanted to go in a different direction.
50 health workers involved
At last, it was time for the historic surgical operation in 2018. It would end up taking 23 hours and involve more than 50 health workers, including plastic surgeons.
“It was the longest day of my life. Since their birth, I had never been away from them even for a single hour. I was worried they were not going to make it.”
But as the procedure went on, the doctors kept assuring her that all was well. Looking at the girls now, it is difficult to tell Blessing from Favour for they are identical and do things almost in the same manner.
They like the same types of foods, clothes, and even toys. Their mother says she sometimes finds it difficult to tell them apart.
“They are inseparable and they are the best of friends even in school. They are playful, and talkative, and help each other even doing their assignments. It has gotten easier with time… as you stay longer with them you will notice the small differences. When they were born, I found it difficult to tell which one had been breastfed, especially when they started crying at the same time,” she said.
And they are inquisitive. Ms Mukiri said they are curious about their story and how they got separated, and like looking at their photos when they were toddlers.
The twins love being photographed, always asking their mother to take photos of them.
Blessing and Favour will often say the same thing at the same time or get the urge to pick up something or move at the same time.
Ms Mukiri says that when one of them is sick, she takes both of them to the hospital because the other one will soon be unwell.
The girls want to work in the medical field when they grow up.
“I want to be a doctor so that I can help my mom and the sick,” they said at different times during the interview. Dr Peter Mwika, a paediatrician surgeon at KNH, participated in the surgery.
He said a mother can know if she is carrying conjoined twins through the standard ultrasound. Depending on the level of training and experience of the sonographers, they can notice anomalies.
It takes a team of specialists to look after such babies. Apart from an obstetrician to handle the mother throughout the pregnancy, there is a need for a psychologist to counsel the mother and prepare her mentally and emotionally as well as a paediatric surgeon, who reviews the images of the babies as they grow.
“This is meant to help with early planning for the medical team on how to handle and deliver the babies,” he said.
The exact cause of conjoined twins is unknown, although it is thought that genetic factors interacting with environmental ones may contribute.
Some studies indicate that the kind of medicines that a mother takes during pregnancy is also a contributing factor. Cases of conjoined twins are rare, one found in every 800,000 births globally.
“Siamese happens when a splitting embryo does not separate completely or when two embryos join. There is no known or specific cause that exists,” Dr Mwika said, adding that the cases are not common in Kenya.
The essence of Siamese surgery is to ensure the conjoined twins live separately as individual human beings who are independent of each other.
Decisions about surgery depend on the body parts shared, meaning that, after separation and their gender, some may face difficulties if they share vital organs such as heart vessels.
There are different types of conjoined twins, classified based on the place they are fused. Craniopagus are fused on the head and could be sharing the skull.
Thoracopagus are twins fused on the chest, where they could share the lungs. Such a set of twins can have three lungs. Omphalopagus parapagus are joined on the side, and sacropagus are fused at the lower back.
According to Dr Mwika, the surgery to separate the two girls took a year of planning between different sets of nurses, paediatricians, doctors, and surgeons in the areas affected.
This included conducting a dry run a week before the actual operation as well as acquiring some of the equipment that would be needed for a successful surgery that would separate the buttocks, bones, and spine.
“It was a delicate procedure and everyone involved had to make sure they did not touch vital organs, and the nerves were next to each other,” he said, adding that a 3D model of the twin’s pelvis was created by a plastic surgeon at the University of Nairobi helped to map the surgery.
Dr Mwika said members of the multi-disciplinary medical team of 50 experts drawn from different medical fields were categorised into four sets and would take turns in the operating room.
The anaesthetic team took time to stabilise the twins before the first set of surgeons came to the operating table.
The paediatric surgeons were the first to do the incision and separate the muscle and various soft tissues on the side of the spine.
They were followed by neurosurgeons, who separated the spine and bone and made sure that the nerves were intact.
“After the separation, we now had two babies and we got another set of operating tables and doctors to continue treating the girls individually,” he said.
After the neurosurgeons were done, the plastic and reconstructive surgeons took over since there were many wounds and skin grafts were used to cover them.
Dr Mwika said when the twins were conjoined they did not have buttocks, so they had to be moulded to a cosmetically acceptable standard.
They were then taken under the care of the critical care team, which monitored them and took care of them in the intensive care unit as they recovered
“It was a complex and stressful operation… we had to manage pressures from all corners such as the media and the hospital expectations on the outcome,” he said.
There were designated surgery managers who coordinated the different teams, including the simulation in the theatre which prepared everyone for the surgery.
The girls left Kenyatta Hospital after 1,000 days.
Ms Mukiri is convinced that she sees a miracle every day as she watches her daughters grow up as independent individuals. For her, it is a dream come true.