Sarah Tumwebaze
23 June 2011
Rosette Tusiime’s dream was to always have twin baby boys. Indeed, she got the twins and for a short while after the Caesarean section, when the doctors announced to her that she’d had twins, she was filled with joy.
However, this was short-lived because as the doctors carried the twins from her womb, she noticed that they were joined.
“My greatest fear was how they would survive. But then, I decided to look at the good side of it. Me and my children were alive and I had God to thank for that.”
The doctors that helped her deliver the babies were mainly concerned about the survival of the children.
“They asked me whether I had the ability to take care of myself and the children and also told me that I’d need to take the babies to hospitals in India or Italy to be separated.” Ms Tusiime is a retail shopkeeper in Kabale while her husband works as a surveillance officer at Simba Casino.
A normal pregnancy
Throughout pregnancy, the 24-year-old small-scale businesswoman thought she was carrying one baby. So did the nurses that were catering to her during antenatal visits.
She explains that she did not go for a scan out of fear of finding out that she was carrying a girl and yet she wanted a boy. Tusiime says the reason she did not suspect that she was carrying twins was because her bump was not any bigger than any other pregnant woman and she didn’t feel any kind of discomfort.
On June 11 at 3am, when the entwined babies were delivered at Kabale Referral hospital, their father, Dennis Owomugisha, was in Kampala. When his wife called with the news, she recounts that he wasn’t happy about the ‘conjoined’ issue but was relieved that mother and babies were fine.
Three days later, mother and babies were transferred to Mulago National Referral Hospital for further investigations. But the news from the scans wasn’t so encouraging.
“They revealed that they were sharing a liver and they both had broken bones in the thighs,” explains the mother, craning her neck to catch a glimpse of her babies in an incubator, five metres from her bed.
Separation possibility
According to Dr Flavia Namiiro, a neomatologist and a newborn health specialist at Mulago Hospital’s Special Care Unit, if, because of any reason, the children are not separated, they could still survive. She adds that they would need special care, extra support and care from counsellors, a psychologist, general physician and a paediatrician.
The only option that their mother is considering is separation. “Those babies have to be separated if they are going to survive, because right now, they are only days old but they pinch each other. It will be hard for them to do anything if they stay like that, especially facing each other,” she says.
According to Dr Namiiro, the twins are joined at the abdomen and part of the sternum (front part of the body). “They also share a major organ, which is the liver. As regards their survival, this is not the right time to determine that because the doctors are still carrying out further investigations as we are yet to establish what other organs might be involved.”
She explains that the future of these twins will be determined by three options. “They can have a liver transplant but that’s not available here. They can also choose to leave them the way they are and finally, the other option might be to rescue one child. However, this will be determined after the whole investigation is done. At the moment we are not sure of how long it will take.” In the meantime, the doctor, who has taken a special interest in this case, says the babies are stable and could even go home except for one thing. “Our major worry is that since they share a liver and yet it has many functions, it might be overwhelming to serve two people and if one got an infection, they would both get it.”
Besides, the doctor observed that the mother has shown signs of fear of being with the babies on her own. She kept on coming up with reasons as to why the babies will not be safe with her like mosquitoes and how they might get hurt when she was told that she will spend the night with them. She also says she still has pains from the operation and thus cannot carry the babies on her own. A caretaker, Catherine Atwakire, helps her support the babies while the mother is breastfeeding.
Atwakire points out the need for extra care while handling the babies saying that she was instructed to hold them by the hands so that they do not further damage their broken legs, for which reason they are not supposed to be moved a lot either. They are put on a hard surface so that while they are being moved, no part of their body is folded.
Meanwhile, even before the operation is decided upon, money is an issue that can’t be ignored, to take care of mother and babies, and later the operation. Dr Namiiro explains, “The babies are delicate, they need clothes and the mother also needs food for all the time she is going to be here and yet at the moment she is not working and her husband earns little money.”
She adds, “All the investigations that we are doing on the babies need money but it’s good that the hospital administration is trying to pay all the fees for the investigations that can be done here.” Tusiime is however also concerned that the tests that can’t be carried out at Mulago prior to the operation will require payments. “We are definitely going to need lots of money, which we will not be able to raise,” she says, “We would welcome any kind of assistance from the public. That seems like our only hope.”
The making of conjoined twins
Dr Namiro explains, “Conjoined twins are formed in the process of development, where identical twins join together in the uterus. It may result when a fertilised egg partially splits or completely separates and then rejoins later”.
In the process of development, there’s normally an ovum released by a woman and a sperm released by a man. When they join together, a foetus is formed. Other times, a woman may produce two eggs and if both are fertilised, there are twins. The twins may develop in a single sack or separate sacs but within the same womb.
Tusiime’s was a case where identical twins were in a single sac and in the process of developing, the eggs joined and the resulting babies ended up conjoined. The last time that conjoined twins were born in Uganda was 10 years ago. They were separated in the US at eight months and are still alive in the US.
Financial help can be sent by mobile money to 0772609292. Tusiime can be reached on 0718854618 and her husband on 0789468774.
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Uganda: Conjoined Twins in Desperate Need of Help