The Sunday TimesPlus

17th November1996



Twins' plight touches the world

by Tharuka Dissanaike

Only when the Caesarean operation was done was it revealed that the babies were joined together from chest to abdomen. When the story of Sandamali and Piyamali - Sri Lanka's second conjoined twins went out on the Internet, offers of help came in from the US, ENgland, Australia and Belgium.

When Hemantha Rupasinghe entered his pregnant wife into the Wathupitiwala hospital on November fourth, they both expected no more than a very ordinary labour and a healthy baby. But the events that unfolded turned out to be very different to their expectations. When the mother found the birth difficult, a scan was done at the base hospital in Wathupitiwala and the doctor found out that she was carrying twins. But only when the Caesarean operation was done was it revealed that the babies were joined together from chest to abdomen. Thus the world's fifteenth recorded pair and Sri Lanka's second pair of conjoined twins were born.

Although the mother had a Caesarean operation, both she and Hemantha went missing hours after the birth of the twins. Perhaps they were reluctant to bear the burden of caring for such unusual offspring. Or perhaps, in their poverty and ignorance they saw it as a social stigma, having an elder son. But later they returned to the hospital and took charge of their rare identical twin girls- who have since been named Hansini Sandamali and Hansini Piyumali. Soon after their birth, the twins were brought to the Lady Ridgeway Hospital in Borella so that they could have more sophisticated care.

Last week, when we met Hemantha he was rushing around trying to prepare passports for his tiny twin daughters, who have to undergo urgent surgery if their lives are to be saved. Surgery will be performed to separate the twins in the Loma Linda University Medical Center in Ontario, California in the United Sates. The hospital will fund the cost of surgery and medical attention while those back home have to take care of the travelling and incubation procedures en route. Already two tickets have been offered to the tiny tots to cover their travelling expenditure. A fund has been set up by the Lions Club of Colombo Regent to collect more money for the babies to facilitate post surgery care and additional expenses that would be incurred in the process.

According to Dr. Y. Kulasekera, Senior Paediatric Surgeon and Director of the Lady Ridgeway Hospital, the babies have two hearts linked together and two livers also closely attached. Apparently their digestive tracts are also connected in some way which has yet not been deciphered by the hospital. "One baby resists feeding," Dr. Kulasekera said. So the other is fed and both are sustained. At birth, the babies had been very healthy, pink and screaming. They had even been breast fed at the beginning. But now they are given a saline drip intravenously and milk through a tube. When The Sunday Times visited the hospital the babies were in the surgical ward, lying in their little cot side by side. Although they looked flushed and healthy, the babies arms were uncomfortably folded at odd angles and there were various tubes running from their bodies. They did not need incubation or ICU care in the hospital.

Dr. Kulasekera explained that the operation is risky because it involves using the surgical knife on the two tiny hearts. The liver separation is relatively easy, he said. And the digestive tract will be separated and some parts replaced using special plastic. After the operation there is no need for complicated health care and expensive drugs, Dr Kulasekera said. But the fact remains that no one can accurately predict what the post-operation care will entail.

"The operation should last 10- 12 hours ," Dr. Kulasekera said. "But we cannot guarantee that both babies will survive." Apparently though, the University Hospital in California is confident that Sandamali and Piyumali have a good chance of being saved by the operation.

This hospital was chosen from among the few international hospitals which answered the call for help and volunteered to do the surgery. Hospitals from Australia, England and Belgium came forward offering help when the news of the twins was put on the Internet by Dr. Kulasekera. "The California hospital was the first to offer," he said.

Dr. Kulasekera said that there is no scientific explanation as to why such births occur. He said that scans done prior to birth showed apparently normal twins and there was no prior indication that the babies would be conjoined. There had been another case of conjoined twins recorded at Lady Ridgeway last year, but they had died within a month or so of their birth. Worldwide there is a very poor success rate for this operation because it involves surgery on the heart. "Other than this, the two babies are perfectly normal," he said.

Nalin Perera, Project Director of the Lions Club of Colombo Regent said that the fund they had set up for the twins would be used to provide for the travelling expenses to and from the United States and post operation costs. "For travelling we had to find an incubator and also provide for the tickets for two doctors and one parent to accompany the twins," he said. The heartrending reports of the twins have touched many a Sri Lankan. Funds are already pouring in from sympathisers local and foreign, most of whom prefer to remain anonymous.

The United States Information Service said that the embassy will grant visas for the travelling team when the applications are submitted. At the time of writing, plans were being finalised to take the babies to California by the weekend . Until then the babies lie together- too close for comfort. What the next week will hold in store for Sandamali and Piyumali none can tell. But the prayers and well wishes of an entire country will be with them all the way.

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