A 21 November picture of Nima and Dawa at the RCH in Melbourne where the twins are being taught how to sit.

Nima and Dawa to come back only after a month of recovery and adjustment 

The first conjoined twins in Bhutan, Nima  Pelden and Dawa Pelden, after being successfully separated on 9 October at the Royal Children’s Hospital in Melbourne, Australia, will be kept at Children’s First Foundation (CFF) retreat center for a month.

The pediatric surgeon with the national referral hospital, Thimphu, Dr Karma Sherab, said the twins need time to recuperate and will not be returning home anytime soon. He said the muscles on their lower abdomens and the lower limbs will take time to develop properly as they have never been used.

Dr Karma Sherab said the girls were supposed to be discharged last week from the hospital but since one of them had a fever, the duration of hospitalization was extended.

The twins, however, were discharged on 25 November from the hospital.

“After the discharge, the CFF has decided to keep the family at the retreat center where physiotherapy and all the facilities needed to catchup to a normal growth will be provided.”

He said when twins will be as good as any other children then they will return back. The Foundation will drop them off to Bhutan. “It will take at least a month because they need to learn to physically function like normal children like, to sit, walk or sleep,” he said.

“The twins are very much loved in Melbourne. They have been showered with all sorts of gifts toys, cards, letters and clothes,” he added.

Meanwhile, the girl’s father, 40-year-old Sonam Tshering is keeping in regular contact with his wife and daughters through video calls. Sonam said, “They were all smiles and seem to be doing well since the surgery.”

Sonam Tshering is from Mongar and works as a messenger at PHPA’s office in Phuentsholing while the mother Bumchu Zangmo, 38, from Trashigang is a housewife. Nima and Dawa are the latest additions to the family, taking the number of children to six.

Nima and Dawa were born on 14 July 2017 in Phuentsholing general hospital by cesarean section. Their combined birth weight was 4.8 kilograms. The twins were immediately referred to the pediatric surgical unit, JDWNRH for further care and management.

Sonam Tshering said it came as a shock when they first learned that the twins were conjoined. He said more than the challenges to raise his conjoined babies, he was mostly worried about the future of the girls. “We didn’t have any idea what to do and were really worried about how the girls will lead their lives,” he said. However, he said he carried a hope that they would be separated in the future. “I can’t express how worried I was, and how happy I am now that they are separated and will be leading individual lives,” he added, “I shall remain always grateful to the doctors and to all the well-wishers for this miracle.”

Dr Karma Sherab said that the parents were counseled on the situation early on, and informed that surgery was not immediately needed as it was always better to wait for at least 6 to 7 months than to do the separation surgery immediately and risk the lives of the twins.

“During the initial 6-7 months, we kept an eye on them while all medical checkups were done to rule out other associated life threatening anomalies,” Dr Karma Sherab said, adding, “Imaging was done to see what organs the twins shared and we were confident they only shared the liver and maybe some bowel loops.”

After the study and discussions in the surgical department, it was agreed that the surgery couldn’t be performed in Bhutan. He said that since the conjoined twins are very rare, and so the decision was made to perform the surgery in the best hospital by the best doctors.

“It was at this time I contacted Dr Chris Kimber, Pediatric Surgeon at Monash Children’s Hospital in Melbourne who was my mentor during my one year fellowship training in Pediatric Urology.” He further added, “The case details and all imaging studies were shared after which Dr Kimber agreed to go ahead with the surgery and asked the Children’s First Foundation to sponsor the whole process.”

Children’s First Foundation then contacted Dr Sherab. “They were very happy and eager to sponsor the separation surgery and then began a long process of paper works of getting consent from the parents, processing medical visas for the twins and the mother.”

Dr Sherab was also in the operating room while the surgery was conducted on 9 October at the Royal Children’s Hospital, Melbourne. “Six senior surgeons, six senior anesthesiologists were among the 25 or so of a team that conducted the surgery,” he said, adding further that the twins shared one liver where the xiphisternum was joined too.

The liver was divided in the middle and put back in place. Plastic surgeons helped in the abdominal wall reconstruction. “Dawa need a prosthetic patch to cover her lower chest defect,” said Dr Sherab. Post operation, he said, the twins did really well and there were no immediate issues.  The procedure took more than six hours.

The Children’s First Foundation sent two volunteers to escort the twins and mother to Melbourne on 2 October.  “With the consent from health ministry, a nurse was deputed as a medical escort as the mother does not know how to speak English.”

Dr Karma Sherab said that while survival rate is 100 percent for the twins, the spine will gradually straighten and will be normal in the future. He said conjoined twins are very rare occurrence. It happens when a single fertilized egg fails to split fully in the early embryo stage.

He said the main challenge during the process was the mother’s health due to intense situation of having to take care of the babies throughout and the stress and worry over the surgery.

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