Published:  12:11 AM, 11 August 2019

Conjoined Rabeya wakes up, Rokeya still unconscious

Conjoined Rabeya wakes up, Rokeya still unconscious

Rabeya Islam has woken up and called her mother while Rokeya Islam is still on ventilation after Bangladeshi and Hungarian surgeons in a joint effort separated the conjoined twins in a "highly risky but so far successful" series of operations.

Doctors at a press briefing on the eighth day of the procedure at the Combined Medical Hospital (CMH) in Dhaka on Saturday said that they did not encounter any complications which were "not expected" and remain "optimistic" about the outcome, reports bdnews24.com. The 3-year-old Rabeya opened her eyes on Friday.

"She called me and said, 'Ammu I want to get on your lap'," her mother Taslima Khatun told the media with tears in her eyes. Rabeya and Rokeya were born in July 2017 to Rafiqul Islam and Khatun, both teachers at a government school in the northern district of Pabna.

Prof Samanta Lal Sen, chief coordinator of the Burn and Plastic Surgery Unit at the DMCH, who coordinated their treatment, said they took up the case in concert with the Hungarian team on Prime Minister Sheikh Hasina's instructions. The Hungarian team of surgeons from the Action for Defenseless People Foundation (ADPF) were the only ones in the world to agree to undertake the task.

The final separation came after at least 44 different types of surgeries were performed, including many in Budapest. There have been 17 such surgeries on twins with fused heads in the world. Only five twins have survived, Major General Md Fashiur Rahman, director general of the medical services of the army, said.

The procedure employed the latest technology in using, for the first time in the world, expander implants to expand their skins and soft tissues, he said. This is a "milestone" for Bangladesh, said Prof Dr Md Habibe Millat, MP, said. "We will always remember this day.

The procedure has only been performed a handful of times around the world. We are one of them. It's a groundbreaking achievement for Bangladesh," he said. "We never thought this type of surgery was possible. It was only so because of the prime minister's encouragement and instructions."
OPERATION FREEDOM

The surgery was code named 'Operation Freedom' in a bid to give the twins a fresh lease of life. It all began nearly 20 months ago. Dr Marcel, pediatric intensivist, said, "It's a success, but we must be realistic and we must be optimistic. We must realize that problems might occur." "We can manage the problems. There weren't any negative consequences or complications which we hadn't anticipated.


Some of them occurred and some of them did not occur." He continued, "We are hopeful that together with our Bangladeshi colleagues, we will do the job professionally.

We have to be optimistic and realistic."The physician also shared some of the challenges that were faced during the operation."They are two babies but the circulation was common, which meant that when we applied a drug, it affected both babies. But the problem was that it had different effects on them. Rokeya had a bad kidney, so the drug reacted differently on her compared to Rabeya."

When the operations started, he said, the surgeons dealt with the twins as one person as part of a single physiological process. But upon separation, they have become two different persons with two different physiologies, which also represented a challenge.

Another challenge was the huge loss of blood during the surgery. "Just imagine, we had to change their circulating blood volume twice and we did it," he said, adding that it was "possible with the help of our fantastic and enthusiastic Bangladeshi team. You should be proud of that".Dr Andres Csokay, a neuro-surgeon, warned of other complications that could arise in the short-term, which typically ranges from two to three weeks.

He said, "Rokeya remains in a precarious state than Rabeya.""Her right side may need further rehabilitation. We'll not be surprised if Rokeya develops hemiplegia (paralysis on one side of the body). We hope it's transitional. Even adults over 50 and 60 years of age can be rehabilitated from this kind of problem," he said.

"Rabeya woke up yesterday. It was the most wonderful news for all of us."Dr Greg Pataki, plastic surgeon and chief coordinator of Operation Freedom, explained some of the possible post-operation problems to bdnews24.com when asked.

"Early post-operation complications may occur in the first several weeks. Middle term complications can occur in the next couple of months. We are planning to perform the fourth stage multi-disciplinary operation in Bangladesh or Hungary after six to 12 months, which will involve modeling of the skull and scar correction and possibly other minor operations," he said."With the common prayers of Muslims and Christians, we sincerely hope the best outcome in the mid- and long-term."

"BANGLADESH CAN DO IT"Over 100 Bangladeshi doctors from different institutes were involved in the procedure along with 35 Hungarian specialists."We lack the facilities (to fully conduct the procedure) but our doctors are capable. If we get the proper facility, we can do it Bangladesh," said Prof Samanta.

Asked why the separation surgery was done in CMH despite the fact the process began in the Dhaka Medical College Hospital burn and plastic surgery unit in February last year, he noted that the prime minister also wanted the procedure to be done at the Sheikh Hasina National Institute of Burn and Plastic Surgery.

"But it's just been inaugurated and we don't have the 'modular operation theatre' which is needed for this surgery," explained Prof Samanta. "So we decided to do it in CMH."


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