The Federal Medical Centre (FMC), Yola, Adamawa State capital, with a team of surgeons led by the Chief Medical Director of the Centre, Professor Auwal Abubakar, successfully separate four-month-old conjoined female twins.
Professor Auwal, a Professor of Paediatric Surgery, said that the team of professionals that were deployed for the surgery included surgeons, anaesthetics, radiologists, laboratory scientists, preoperative nurses, and cleaners.
He stated on the separation of the four-month-old conjoined female twins:
“We have a successful separation of conjoined female twins (Omphilopagus). This development was recorded following a team work by different medical units.
The surgery was conducted on May 14, and the chances of survival of the twins are excellent.”
Professor Auwal said it took his team four hours to perform the operation – separating the four-month-old conjoined female twins, which was the second of its kind in the hospital.
To this end, Auwal said Nigeria had medical personnel that could compete with their counterparts in developed countries.
What informed your interest in these kinds of cases?
These are very rare problems and any time they happen, they usually make the parents very anxious and agitated because of their very poor background. Some of them have few places where they could look for help and this is also a problem that tests the team work of the healthcare service.
So what do you need to do first?
In this kind of problem, you need to have good coordination in the different members of the team. All over the world, when you have conjoined twins, you will need to meet and assign roles and get the different parts of the teams to work together because if there is any problem of prolong surgery then you tend to have complications and as you know, there are many other successful separations in Nigeria so this is not the first time.
One other thing is interest and that interest has to be proper and total interest. You need to have the interest of the patient, his background, his problem because you need to keep them very close so that you monitor their growth and attend to health issue that may arise. With that, you will determine the chances of success which is usually higher. This helps the team to get accustom to them and members of the team will be able to fine tune their plans. These cases are not common so we are very privileged to have them.
How was this particular surgery done despite the fact that JOHESU was on strike as at that time?
The doctors were all working. We had the surgical team and the anesthetic team and those ones are basically doctors so they were around. For the theatre nurses, we actually have contract staffs who are retired nurses with vast experience and many of them were around. Some members of the striking workers even volunteered to join us and the lab was handled by lab scientists who are youth corps members and interns. We also had cleaners that didn’t join so they were part of us. We decided to do it because we didn’t want to lose time. The babies gained weight and their condition was optimal so we wanted to seize that time and thank God we did successfully.
How long did it take for you to prepare them for surgery?
Six weeks. They were here for six weeks. At that time, we did the investigation, the CT scan, ultra sound and other radiological investigations. This was to establish the organs involved and the extent of their conjoining. We were able to successfully bring that out clearly. It also gave us opportunity to meet several times. In fact we also took the babies to the theatre at different times to rehearse positioning, what we need to do, where we need to keep this and that, etc.
How do you get to identify the babies since they are identical?
That is why the rehearsing exercise is critical because you also have to identify the babies. In this case, one was called ‘Baby Red why the other one Baby Blue’. So we had color body for their drugs and everything and even the people handling them. If you look at the video, you see some red and blue. The baby on the left blue and the one on the right red. We also use R for red and B for blue. Because you don’t want to be confused. Drugs were calculated half for each of them because their combined weight was close to 12 kg so we give each of them drugs by 6 kg. This is very important because these are areas you can make mistakes. You can over dose because it’s combined wealth. You have to divide everything carefully including the IV fluids. Even the teams and everybody knew that he or she is for baby blue or red for easy identification so there was no waste of time when we went into the operation.
Each team already knew their roles and what to do. For the surgeons, we were together initially but when we finished the operation, we broke into two groups for the closure. I did closure with some of the team, and then Dr. Wabada did for the second baby with his team. After that they were transferred to the intensive care unit (ICU) and the recovery was very fast. We thought they will spend some days but after the second day they were [okay] and we just transferred them to the ward. The post operation recovery both anesthesia and surgery was very impressive beyond our expectation.
How many hours did the surgery take?
The surgery lasted for only four hours and we were done with everything.
Is there any medical risk that the babies may face as they grow?
Not at all. As far as we are concerned, they just need to continue with their immunizations. Otherwise, there is no risk at all from the surgery. They have normal function of any other organ so the risk is like any other normal baby.
How many people were involved in this surgery?
About 26 people. But I must say that everybody is important. We had cleaners, surgeons, anesthetists, ICU nurses. The number could be more but the main people are 26. Before the surgery we had people from the laboratory and radiology who helped in the investigation.
What do you call this type of conjoined twins?
This is omphalopagus. When you say omphalopagus is above the umbilical cord up to the lower chest. When it extends up the chest then is thoracopagus.
Would you like to disclose the total cost of this operation?
Well I don’t want to go into that. We didn’t even look at that. I felt these people needed help and the hospital took up the responsibility so we didn’t even look at that. Like I told you, they have been here for six weeks and now is more than three weeks post-surgery. It’s good to acknowledge the Federal Neuropsychiatric Hospital Maiduguri and Adamawa German Medical Centre who did the CT scan free. We don’t have a CT scan here at the hospital. You can see they are still here.
Is medical tourism outside the country for this kind of cases necessary?
I think for most of them, people who may want to sponsor may also want to get some benefit from the travel because sometimes you see government or some organizations will want to take some responsibility. But like you know, there are many successful separations in the country. We have capable hands who will handle this. We may not have some of the highly technical gadgets but for the human resources we have them in abundance.
As a surgeon, what first comes to your mind when you take a knife to perform an operation?
The truth is, even in ordinary surgery, there is no surgery that a surgeon will want to do without his adrenaline going up. But with team, you are actually positive and looking forward to when they will be separated. For these babies, for most of the time they have been together but they cannot sleep on their backs until after they were separated and you could see the excitement even within the theatre. Everybody was happy. The joy was spontaneous especially that we broadcasted the operation live within the hospital for other people to watch. The thing with our country is for us to believe in ourselves and for us to equip our health institutions to the standard that we have like in other parts of the world. I believe if we give attention to health, we should be able to upgrade some centres – maybe at regional levels that we can find anywhere in the world. If you go to US and UK you find many top Nigerian professionals there.
What do you lack here at FMC Yola?
What we lack here is the modern imaging equipment machines. CT, MRI and other radiological equipment. You can see that in this case, we depended on other facilities to do CTs. We need to upgrade other areas like; theatre, lab, etc. we are doing well but we can do better.