By Luminous Jannamike, Abuja
Goodness and Mercy Martins were born attached to each other at the heart, diaphragm and liver on August 12, 2018. Before now, it was unheard of in history that twins sharing such vital organs survived separation surgery in Nigeria.
So, within hours of their birth, the twins were referred from the Federal Medical Centre, Keffi, Nasarawa State to the National Hospital Abuja for emergency care owing to the complexity of their case.
Surgeons in Abuja spent over 14 months rehearsing the final separation procedure on a 3D simulation of a conjoined heart and other delicate organs.
To the amazement of their parents and the doctors, however, the conjoined sisters survived four complex surgeries to live independently.
Inside The Womb
A woman releases two eggs during ovulation. One may be fertilized if she engages in unprotected sexual intercourse during her menstrual mid cycle.
The fertilised egg may split into two embryos with each part having its own amniotic sacs.
However, if the splitting process does not complete; the embryos become conjoined.
Since only one egg is involved, conjoined twins are always the same gender and are genetically identical.
According to a 2017 paper in the journal of Clinical Anatomy, conjoined twins are extremely rare, with an incidence of one in 50,000 births.
Success of separation surgery depends on where the twins are joined. The most common type of conjoined twins is that fused at the abdomen. At least one twin survives 75 per cent of the time.
Medical experts can only tell which organs the siblings share and, therefore, plan surgery after they are born.
Those joined are the heart are the most difficult to separate hence possess the least chance of survival.
Only five per cent of them live longer than 24 hours.
“Goodness and Mercy are such resilient girls,” said Michael Edeh Martins, their father, on the day the girls were discharged.
Minutes after their birth, doctors at FMC Keffi told Martins and his wife, Maria, that there was almost no way the girls could make it in Nasarawa.
According to preliminary diagnostics, the conjoined twins appeared to share the same heart which caused the family huge anxiety.
But, determined to keep their little girls, the Martins family sought a second opinion – and found the answer they were looking for.
Doctors in Keffi promptly referred the conjoined babies to the premium tertiary healthcare facility in the nation’s capital for emergency care.
Experts at the National Hospital did a close analysis and found that each girl had her own tiny heart which were almost beating at the same time and attached to one another at the atrium.
Also, the experts found that the twins had only one liver but it was big enough to pass for the size of two.
Aside from being joined at the two most delicate organs of the body, the Martins twins were born with a condition known as omphalocele, a birth defect that left a section of their intestine sticking outside their navel.
The odds were still stacked against them, but there was a chance. However, the separation surgery and other sundry needs of the conjoined sisters would cost about N20 million.
Born with a combined birth weight of 5kg via c-section, their father, an Oturkpo-born painter, and their unemployed mother could barely afford to meet their own basic necessities let alone N20 million surgery cost.
After doctors took necessary scans of their organs to make 3D printed copies for further analysis, the sisters’ case was brought before the National Hospital’s Chief Medical Director, Dr. Jaf Momoh, who mobilised resources for surgery.
Momoh said the hospital management decided to fund the care and the entire processes leading to the major surgical procedure for the separation as its corporate social responsibility.
He also approved the setting-up of a multidisciplinary team of medical experts led by Prof. Emmanuel Ameh, a Chief Consultant Pediatrics Surgeon, to handle the case of the Martins sisters.
The 78-man medical team spent over one year meeting, planning and rehearsing the procedure on a 3D print-out of a conjoined heart.
With no clear separation points in their fused organs, the experts would have no option but to cut some vessels. However, they must do their best to keep it to a minimum.
The surgery finally took place last November, stretching out an agonizing 13 hours to have the liver separated, the diaphragm, then the heart.
The operation to treat their omphalocele was not a smooth ride as one of the sisters recovered within hours, while the other had complications that delayed her own recovery.
According to Ameh, plastic surgeons on the team were particularly worried that a large section of the girls’ chest would be open and at risk of being infected once they were separated.
He, however, added that they had to create artificial skin large enough to cover the area, which took several weeks to achieve.
“We needed to determine if they could live independently when they are separated. We found out that they were sharing a diaphragm and one liver was serving both of them, but all other organs were separate,” Ameh stressed.
Despite the challenges that bedevilled the surgery, he described the twins’ overall recovery as astronomical.
Now, after weeks on ventilation machines, they are stable and continue to defy the odds against them.
Though the outlook for them is very strong, there are fears of possible post-surgery complications.
The National Hospital says the separated twins will have to be monitored over the next few months to ensure they lived healthy lives.
Board Chairman of the hospital, Mrs Partricia Etteh, said the hospital would give the parents N200, 000 for the upkeep of the babies.
She also called on well-meaning Nigerians to assist the parents to properly cater for the twins.
Responding to the call, Minister of Women Affairs, Mrs Pauline Tallen, commended the medical team and assured of automatic employment for the unemployed mother in the Federal Civil Service.
On his part, the Minister of State for Health, Adeleke Mamora, who is also a father of twins, announced a donation of an undisclosed sum to the parents of the separated twins.
According to the father of the girls, “to see my daughters’ thrive in the ICU, then come off the ventilator and now discharged was unbelievably true and exciting”.
“After our daughters’ birth, we were scared but abandoning them was never an option. I just couldn’t do that… and look I made the right decision,” Martins said.
On her part, the mother of the twins, Maria, said at some point, she was told to prepare for the worst as the twins’ chances of survival were so slim.
“I was told by some friends and relatives to prepare myself that there may no longer be any heartbeat from the girls after the separation surgery,” she said. She expressed appreciation to government, staff and management of the National Hospital, as well as family and well-wishers for the support that saved his girls.