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Australian doctors preparing to separate conjoined twins Nima and Dawa

Grant McArthur, October 8, 2018 8:51AM Herald Sun

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Conjoined twins Nima (left) and Dawa after scans at the Royal Children's Hospital in Melbourne. Picture: Alex Coppel media_cameraConjoined twins Nima (left) and Dawa after scans at the Royal Children's Hospital in Melbourne. Picture: Alex Coppel

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Australian doctors are preparing to separate conjoined* twin girls in a tricky life-changing operation.

The 14-month-old twin girls — Nima and Dawa Peldon — are from Bhutan in the Himalayan mountains and travelled to Melbourne with their mother in the hope a team of surgeons at the Royal Children’s Hospital can separate them.

They are joined at the skin across their lower chest and tummies. Doctors believe the sisters also share a bowel (which absorbs most of the nutrients from what we eat and drink) and liver (which breaks down fat in our body and filters the blood) that can both be safely split.

Importantly, they appear to have their own hearts and lungs.

Twins Nima and Dawa with paediatric surgeon Dr Karma Sherub and mum Bhumchu. Picture: Alex Coppel media_cameraTwins Nima and Dawa with paediatric surgeon Dr Karma Sherub and mum Bhumchu. Picture: Alex Coppel

Nima and Dawa are so identical their parents cannot tell them apart without looking for a small, faint birthmark on Nima’s right arm.

While they look the same, they have very different personalities.

Nima is the more dominant* twin, increasingly trying to push Dawa and even manipulating* their bodies so she can kick her sister in the back of the head when she wants to move but her sister won’t play along.

Dawa is happy to lay around and watch cartoons on a mobile phone or play with money — until her stronger and healthier sister disturbs her by wanting to chat or play.

The sisters are extremely fond of each other. They spend most of their time happily playing together on their bed.

Conjoined twins Nima and Dawa. Picture: Alex Coppel media_cameraConjoined twins Nima and Dawa. Picture: Alex Coppel

They cannot sit but they can stand, though they rarely allow each other to. For one to stand up her sister has to agree, however they seldom want to move at the same time or in the same direction.

They also disagree about when it is time to sleep and won’t allow each other to rest. The lack of sleep and stress has added to their nutrition problems and worsening health.

The normal development other babies enjoy is proving dangerous for Nima and Dawa.

When they began trying to crawl one twin dragged her sleeping sister over the side of the bed, crashing both head-first into the floor.

Nima and Dawa are joined at their stomachs. Picture: Alex Coppel media_cameraNima and Dawa are joined at their stomachs. Picture: Alex Coppel


HOW THE SURGERY WILL WORK
Despite running many tests, X-rays and scans, doctors will only know exactly which operation they need to perform when they get into the operating theatre.

But RCH head of paediatric* surgery Mr Joe Crameri is confident of a good result.

“They are two twins that seem, on the limited information that we have got, separable*, with both of them then able to function normally — that is what we are aiming for here,” Mr Crameri said.

“If we can get them separated and give mum and dad two kids to look after, then that is fantastic.”

A team involving at least six specialist surgeons and dozens of anaesthetists*, nurses and intensive care specialists are being prepared for the operation, which could take place in a matter of weeks.

Director of Anaesthesia and Pain Management Dr Ian McKenzie with twins Nima and Dawa at the Royal Children's Hospital in Melbourne. Picture: AAP media_cameraDirector of Anaesthesia and Pain Management Dr Ian McKenzie with twins Nima and Dawa at the Royal Children’s Hospital in Melbourne. Picture: AAP

With surgery expected to last five hours or more, the first step in Australia will be further building the girls’ strength and undertaking 3D scans.

When the day for separation finally does come around it will begin with a single operation but involving two complete teams of surgeons, nurses and anaesthetists.

Once the conjoined sections of the Nima and Dawa’s bodies are severed the surgery will break into two separate operations, with one team looking after each of the sisters in two operating theatres to rebuild their individual bodies.

The sisters are expected to need up to five days recovering in intensive care, followed by weeks in a hospital ward.

FUN FACT
All Bhutanese twins are called Nima and Dawa: the first born is named Nima, after the sun which rises first, and the second Dawa, after the later rising moon.

Conjoined twin sisters Krishna and Trishna at age 3. Picture: AAP media_cameraConjoined twin sisters Krishna and Trishna at age 3. Picture: AAP
Separated twins Krishna (left) and Trishna. media_cameraSeparated twins Krishna (left) and Trishna.

ANOTHER SUCCESSFUL SEPARATION
In 2009, surgeons at Melbourne’s Royal Children’s Hospital performed a marathon 32-hour operation to separate Bangladeshi twins Trishna and Krishna.

Despite being joined at the head and sharing brain material as well as vital blood vessels, surgeons Wirginia Maixner and Alison Wray remarkably saved both girls’ lives.

A small bald patch on the side of Trishna’s head is the only physical sign of their separation.

The girls were brought to Australia from a Bangladesh orphanage by Moira Kelly, the woman who later became their legal guardian*.

The girls still live with Ms Kelly and both Trishna and Krishna enjoy swimming and music and dance.


GLOSSARY

  • conjoined: joined by touching or overlapping
  • dominant: more powerful
  • manipulating: controlling
  • paediatric: medicine dealing with children
  • separable: able to be separated
  • anaesthetists: medical specialist who puts patients to sleep to avoid pain
  • guardian: person with legal right to care for someone

LISTEN TO TODAY’S STORY

QUICK QUIZ

  1. Where are Nima and Dawa’s bodies joined?
  2. Which country do they live in?
  3. How long is the separation surgery expected to take?
  4. Which twin is the dominant one?
  5. What do the names Nima and Dawa mean?

CLASSROOM ACTIVITIES
1. Questions for the doctors
While the details of the separation are interesting to us, for Nima and Dawa’s family it is probably a very anxious time. It would be important for them to know as much information as possible about the procedure, recovery and the twins’ lives after the separation.

Make a list of all the different questions you would ask the doctors working on this case if you were the girls’ family.

2. Extension
Can you explain why Nima and Dawa have travelled to Australia to be separated instead of having the operation in Bhutan? How do you feel about this?

Time: Allow 20 minutes
Curriculum links: English, Science, Ethical Capability

VCOP ACTIVITY
After reading the article, with a partner, highlight as many connectives as you can find in pink. Discuss if these are being used as conjunctions, or to join ideas and create flow.

HAVE YOUR SAY: Describe how you think the twins will feel once separated.
No one-word answers. Use full sentences to explain your thinking.

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