Separating conjoined twins is just like performing circumcision, nothing to celebrate-Larry Mweetwa

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mbwiliA Zambian medical expert based in the United Kingdom has attempted to dampen the celebrations across the country that has followed the successful separation of conjoined twins at UTH on Friday.

Larry Mweetwa, a Doctoral Expert in Pharmacy and a well known UPND cadre charged that conducting such operations has now become so easy with the advancement in medical technology.

Mr Mweetwa wondered why the entire nation is ecstatic about the operation when it is now very simple to separate conjoined twins.

He said the level of excitement that has followed the successful operation on the twins, Bupe and Mapalo goes to show the level of under development currently present in Zambia.

Mr Mweetwa said separating conjoined twins is now as simple as performing circumcision.

Below is Mr Mweeta’s full statement posted on his Facebook page

Yesterday I was bombarded with inbox texts asking me to explain in detail about the miracle that took place at UTH because ZNBC didn’t cover much detail.

Well it was the operation of babies who were joined at the tummy from birth! First congratulations to our doctors who carried the operation but success will only be judged by recovery of both twins. Well first and foremost may I put a disclaimer here that i am not a surgeon and may I also state here that this is not the first time this operation has taken place on an African soil. Luka and Joseph Banda were probably the first Siamese to be operated in 1998.

The thing I want to address though is the hype and excitement this caused and it made me have a reflection on our health system and made me feel sad. It just shows how backward our healthcare system is.

Not to take away from the surgeons who carried out the operation, kudos and job well done. But to be honest, conjoined twins surgery is no longer rocket science to cause this hype and jubilation.

A number of shithole countries have performed these surgical procedures. South Africa, Malawi, even apa pa Zaire or Congo.
The Zambian case was actually a simpler one or less complicated because it wasn’t a craniopagus (joined at the skull) which is more complex.

1. Anaesthesia to make both twins sleep can be complicated.
2. Needs good judgement by surgeons.
3. Post surgical intervention and recovery rate is what determines success.

For you to understand the UTH case, I will first of all explain the complexity of craniopagus surgical operation.

Please allow me to use simple vernacular not ci medical so that nabakabova bali pa Facebook can understand. Kudaala iyi operation benze ku icita mu one stage operation or mitu nizogwilana. But problem iyalipo na approach iyi is that kambili nangu ntile ilingi ama twins aba bala cita share tuma veins. So because of this, during operation one of the twins will have to sacrifice draining the brain blood supply mechanism by giving one twin.

It a complex conservation mechanism which prevents blood flowing away from the parts of the brain deprived of their venous drainage, which in turn causes an increase in pressure in the brain, which eventually leads to brain damage or death.
So Iyi single stage operation especially kuno kubuzungu we have stopped using it. Because it has been proved to be quite fatal or have caused significant brain damage.

Iyi iliko best, Multi-stage surgery separates the twins in stages. So ngati tuma twins batu cita operate muma stages so It has the effect of reducing the rise in venous pressure seen to a level that does not cause brain damage. So that vija brain gradually icita recover from the partial venous separation and so kukapita ce tuma days tun’gono, tu ma new venous channels open and the venous pressure returns to normal as blood flows away through these new channels. Once utu tuma venous pressure twabwelela ku normal, basi futi mwaba bweza for the next stage-operation can be undertaken and the process repeated. In this way, the brains are gradually and safely separated.

So based on the above explanation you can see the complexity of the operation, because in certain instances procedure will mean sacrificing one twin’s life to save another.

OK apa peve sini nga name, technology ya cita improve, but the classic one I know is
the virtual toolbox, called BrainBench, which was developed by CieMed,a joint project between Hopkins and the National University of Singapore established in 1994. BrainBench combines many two-dimensional images of a patient’s brain obtained by CT or MRI into a single, three-dimensional virtual brain. The effect is like recombining slices of bread back into the original loaf. So vi ja Mu 3D ngati Ba cita operate it’s like in real brain wa igwila ku manja so.

The workbench ili na station ya computer na Ka monitor suspended so it projects brain images olo kulangana pa bongo down onto the work area. So then doctor usama ma gilazi ali special and looks down through a chest-high glassscreen at the image of the patient’s brain. The glasses let the surgeon see the brain in three dimensions na mu mpanzu mpazu zyotatwe and BrainBench’scomputer program lets the operator manipulate the image of the3-D brain image as in a real operation. This makes it easy kwandaanya boongo atumizipe tunyamuna bulowa.

Coming back to the UTH case conducted yesterday, the demand or level of risk is not as severe as the skull joined twins as it was a simple stomach organ sharing, it was not even a ribcage shared kind. Here is a little background. In about 30% of cases, conjoined twins are joined at the chest, the most common form encountered. What would be shared between the twins?

In most cases conjoined twins will have tuma shared;
1. Inter connected Intestines
2. Liver
3. Pericardium
4. Hepatic vein crossover etc.

So, separating these organs is not rocket science. This then opens a discussion that we need to advance our level of practising medicine if in 2018 conducting a conjoined twins surgery still makes huge headline news in a country then our level of practising medicine is still a shithole. It just demonstrates how backward we are at practicing medicine.

Let me put this into perspective, what we are cerebrating now is nothing, 20 years ago in 1999 on 7 July, Ghana made their first Siamese operation. Congo 15 years ago, Malawi another shithole country did it 5 years ago, surely as for me I see no sense to celebrate this but it just breaks my heart and makes me do an introspective analysis of our level of practising medicine and conclude to say we are still at a shithole level and PF must allocate more resources in cutting age medical technology training more Medical Doctors, Pharmacists, Nurses, Radiographers, Biomedical scientists and Physiotherapist.

Here are the unsung heroes whom you rarely hear about but are behind the success of any operation.

-Without an anaesthetist contributing their skills to sedate the patient, the Surgeon conducting the operation is nothing but a shithole Medical Practitioner.

-Without a MRI/CT Radiographer taking images of the patient, the Surgeon conducting the operation is nothing but a shithole Medical Practitioner.

-Without a Biomedical Scientist to carry out diagnosis and analysis of blood samples the patient, the Surgeon conducting the operation is nothing but a shithole Medical Practitioner.

-Without a theatre nurse who arranges the operating table and puts instruments, sutures etc in place, the Surgeon conducting the operation is nothing but a shithole Medical Practitioner.

-Without a physiotherapist contribution to help in the recovery process of the patient after surgery, the Surgeon conducting the operation is nothing but a shithole Medical practitioner.

– Without Pharmacists participating in multi disciplinary surgical patient management, the Surgeon conducting the operation is nothing but a shithole medical practitioner.

In civilised countries establishment of OR (Theatre) pharmacists has had a huge significance in patient recovery and adverse event reactions, teams in the preoperative area can reduce the incidence of adverse drug effects because the pharmacist can review orders prior to administration.
OR pharmacists can have a significant effect on hospital compliance with Surgical Care Improvement Project measures. Several regulatory compliance processes can be monitored and addressed daily by OR pharmacists. Initiating new processes and standardizing anaesthesia drug trays can decrease medication errors, improve organization of anaesthesia medications, and encourage safe injection practices. Another key role of the OR pharmacist is to manage narcotic dispensing and reconciliation processes that inhibit drug diversion. Inclusion of a pharmacist on the multidisciplinary OR team should be standard practice in all hospitals.

Larry L Mweetwa
A Doctoral Expert in Designing Antibiotics and ARVS

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