For the first time in the history of childbirth in The Gambia, one Ramatoulie Jallow, a resident of Serrekunda London Corner, on Wednesday afternoon, went under the knife in a major caesarean operation that led to the birth of  conjoined female twins.

The caesarean birth was reported to have been successfully conducted at the Gambia Family Planning Association (GFPA) Clinic in Kanifing by Dr Ndabo Manneh-Camara, following a thorough examination. The twins are joined at their stomachs. They were later referred to the Neonatal Unit of the Royal Victoria Teaching Hospital.

Dr Ndabo Manneh-Camara, a medical doctor of the GFPA Clinic, who conducted the operation, said this development was the first of its kind in the country and such a case is very rare in the world.

"I have been in the field [of medicine] for 21 years, but this is the first time that I have came across such a case,'' Dr Camara said.

The insight

The GFPA's medical doctor explained that the mother of the twins - married with three children - came to her clinic at around 1:00 pm on Wednesday with labour pain.
 
"When I checked her, I realised that her abdomen was very big and that everything was not normal. The moment I realised that she was not in active labour, I quickly suggested a scanning. The scanning report revealed a multiple pregnancy and this suggested a delivery by operation, which I had initially suggested," Dr Manneh-Camara said, adding that "I wasted no time in going ahead with the operation".

According to Dr Manneh-Camara, during the course of the operation, she realised that the twins were joined and could not be separated. She disclosed that after the operation, she referred the twins to the RVTH Paediatric Unit for further investigations.

However, Dr Manneh-Camara, who has undoubtedly earned fame for herself as the first Gambian doctor to handle such a rare and major maternity case, admitted that she was unsure of whether the twins share the same organs, but noted that their mother's condition is normal.

Asked about what is responsible for such a phenomenon, Dr Manneh-Camara attributed it to genetic factors, which occur at the early stages of pregnancy.

Specialist care

Noting that the operation for a possible separation of the conjoined twins is not available in the country yet, the veteran doctor called for  urgent financial assistance to facilitate an overseas operation in order to save the young lives.
"Their parents are not financially strong and only urgent intervention from all stakeholders can complement their efforts to separate the twins overseas," she added.

Dr Tamsir Mbowe, director of Health and Medical Services, who has visited the conjoined twins at the Neonatal Unit, said the twins have a "high chance" of survival.
"The good news is that the visceral organs of the twins are not connected together according to the CT Scan conducted at the RVTH," he added.

Urgent assistance

Dr Mbowe, himself a well-known gynaecologist, said two hospitals have been identified to conduct the operation in Europe at a cost of D1.6 million. He then called on the public to assist in meeting the financial cost of the special operation for the separation of the twins in Europe.

Ramatoulie Jallow, the mother of the twins, who is currently admitted at the GFPA Clinic, also appealed for assistance to save the lives of her twins.
Yankuba Dibba, the executive director of GFPA, stressed that the twins need urgent financial aid in a bid to also go under the knife overseas.

Willing individuals, organisations and institutions, who wish to help can render assistance by contacting 991 4535/ 776 4535, or tamsirmbowe@yahoo.com.

Scientific evidence

Conjoined twins are extremely rare, occurring in as few as one in every 200,000 births. The twins originate from a single fertilised egg, so they are always identical and of the same sex.

The developing embryo starts to split into identical twins within the first two weeks after conception. However, the process stops before it is complete, leaving a partially separated egg which develops into a conjoined foetus.

The birth of two connected babies can be extremely traumatic and approximately 40-60% of these births are delivered stillborn with 35% surviving just one day.

Historical records over the past 500 years detail about 600 surviving sets of conjoined twins with more than 70% of those surviving pairs resulting in female twins.

Historical records

The earliest known documented case of conjoined twins dates from the year 945, when a pair of conjoined twin brothers from Armenia were brought to Constantinople for medical evaluation. It was here that they were determined to be acts of God and the birth of conjoined twins was considered a proof that the male's sexual prowess was truly twice that of the average man.

However, the Moche culture of ancient Peru depicted conjoined twins in their ceramics dating back to AD 300. The English twin sisters Mary and Eliza Chulkhurst, who were conjoined at the back (pygopagus), lived from 1100 to 1134 and were perhaps the best-known early example of conjoined twins.

Other early conjoined twins to attain notice were the "Scottish brothers", allegedly of the dicephalus type, essentially two heads sharing the same body (1460-1488, although the dates vary); the pygopagus Helen and Judith of Sz_ny, Hungary (1701-1723), who enjoyed a brief career in music before being sent to live in a convent; and Rita and Cristina of Parodi of Sardinia, born in 1829. Rita and Cristina were dicephalus tetrabrachius (one body with four arms) twins and although they died at only eight months of age, they gained much attention as a curiosity when their parents exhibited them in Paris.