The predisposing factors that will make an expectant mother give birth to conjoined twins remain unclear. However, there are several cases of conjoined twins reported in Nigeria. In the past, such patients would have to travel to Asian, American, or European countries for separation. This was an expensive adventure that many Nigerians cannot afford.
There seems to be a breakthrough in the medical field in the country in recent years. Thus, it appears, the complex procedure for the separation of conjoined twins can now be performed by local doctors. A team of 78 doctors has successfully separated a set of conjoined twins, Goodness and Mercy. Consequently, this is the first time that such a procedure will be performed in the country.
The twins were born at the Federal Medical Center, Keffi, Nasarawa State on 13th August 2018. Because of their condition, they were referred to the National Hospital Abuja the following day. The twins had a protruding tummy and lower chest and shared one liver. The over 12-hour operation was successfully done on November 14, 2019. Explaining the procedure, the leader of the team, Prof. Emmanuel Ameh said,
“We received the twins on August 14, 2018, and quickly constituted an inter-disciplinary team, including pediatric surgeons, cardiac surgeons, plastic surgeons, nurses, imaging experts, dermatologists, and other experts. One of the major challenges was that the twins came with their intestines bulging out of the lower part of the tummy, which we quickly resolved. We also needed to determine if they could survive separately after separation. We found out that they had two separate hearts that were normal, but with a common cover. They also shared the lower half of the chest and there was only one liver serving the two of them.”
Possible Factors Influencing Increasing Medical Tourism in Nigeria
With a team of Nigerian doctors successfully completing the procedure to separate the conjoined twins, it is baffling to know that Nigerians spend billions of naira on medical tourism annually. There are a number of reasons that can influence this. However, the Minister of Health, Dr. Osagie Ehanire noted that may have something to do with the lack of confidence in the country’s health sector. According to the minister,
“One of the reasons why some Nigerians travel abroad for treatment is because they lack confidence in the health sector. They believe that we do not have specialists and the required medical equipment to handle sensitive cases.”
Goodness and Mercy were recently discharged from the National Hospital Abuja following their successful recovery from the surgery. It is unlikely that a single case of separation of conjoined twins is enough to change the mindset of the majority of the populace. However, it shows that Nigerian doctors are in a better position to handle more complex procedures than before. According to the minister,
“This is a demonstration of excellent teamwork, which also shows that with confidence in the health sector, we can do great things in Nigeria. The ability of these experts to work together means that we can stand up to many international hospitals, as far as advanced surgery is concerned.”
The Cost of the Surgery
The cost of surgery for the separation of conjoined twins can exceed $200,000. According to the minister of state for health, Mr. Olorunimbe Mamora, it would have cost the parents N20 million to get the surgery abroad. However, for the Mariah and Michael Martins, it was totally free. The hospital management took care of the cost of the surgery. The poor parents were full of gratitude to the health ministry and the hospital management. The 35-year old father is a painter and earns around N40,000 (approx. $110) monthly.
Mrs. Mariah, on the other hand, was unemployed. The parents who are indigenes of Benue State were particularly thankful for the hospital’s “care and concern even without charging them throughout their stay.” At the end of a small ceremony to mark the discharge of the conjoined twins the Minister of Women Affairs and Social Development, Mrs. Pauline Tallen announced ‘automatic employment’ for Mrs. Mariah.
The Possible Causes of Conjoined Twins
Identical twins occur when a fertilized egg splits into two. However, conjoined twins result when there is an incomplete division. The belief is that if the separation occurs later than 8—12 days after conception, there is a high chance of incomplete separation. Also, there is another theory that suggests embryos fuse during early development. However, the possible cause of both scenarios remains unknown.
There are lots of complications that can arise for the mother and the conjoined twins. For the mother, birth has to be through a cesarean section (C-section). For the babies, the chance of survival is low especially if they share vital organs. It is not surprising that Mariah and Michael Martins have called the separation of their twins a ‘miracle’.