Doctors reveal complex, multi-country mission to help conjoined twins

The race to save a conjoined twinExclusive by Papua New Guinea correspondent Marian FaaTopic:Health Link copiedShareShare articleGiggling from his stroller, a baby is wheeled through the foyer of a large hospital in Sydney, beaming at the many doctors and nurses who stop to say "hello". "Everyone loves him, he's a superstar," remarks Gordon Thomas, a paediatric transplant surgeon at Children's Hospital, Westmead, who operated on the child. Sawong Kevin was born in remote Papua New Guinea in October. He was attached to his brother, Tom, at the chest, abdomen and pelvis. Fetima is focused on her son Sawong after his long medical battle. (ABC News: Marian Faa) Fetima Tinggar smiles while holding her baby son in hospital. (ABC News: Scott Preston) The twins shared multiple major organs, and doctors knew if they weren’t separated, both would die. They were flown to Port Moresby for care, but the country's underfunded health system did not have the means to surgically separate them. The rare case drew international attention, with foreign governments and hospitals in Germany, India and Australia investigating ways to assist. Eventually, a team of doctors from Sydney was invited to fly to Port Moresby and assess the twins. Among them was Dr Thomas, who said a case like this only occurred every 10 or so years. The public hospital where the newborns were being treated initally did not have a neonatal intensive care unit. (Supplied) The surgery needed to separate the twins could not be performed in Papua New Guinea. (ABC News: Marian Faa) "There's nothing in the textbooks about a situation like this," Dr Thomas said. "Every case of conjoined twins is unique in its own way." Dr Thomas is among the team of specialists speaking exclusively with the ABC about the complex and detailed mission to save Sawong, and the heartbreaking sacrifice his brother Tom had to make. Dr Thomas and the team spent days examining Tom and Sawong to determine whether they could be separated. "We had lots of unusual clinical findings in the twins that we had to understand," he said. "For instance, Tom's upper part of the body was completely blue, but the rest of his body was pink. How do you explain that?" Smaller twin Tom had a congenital heart defect and only one kidney. (ABC News: Marian Faa) Tom and Sawong attracted international attention due to their rare medical condition. (Supplied) Working with the basic equipment available in Papua New Guinea, the team took scans, drew diagrams, and gradually built a picture of what was going on. Tom and Sawong shared a liver, parts of their gastrointestinal tract, and several major blood vessels. "They are complex and difficult problems to solve," Dr Thomas said. Tom also had a congenital heart defect and tiny lungs, so was relying on Sawong to keep him alive. "We could see Sawong breathing very fast. We could see him really hungry. We could see his heart beating very fast because he was actually doing the work of two," Dr Thomas said. The prognosis they reached was difficult. "Tom had a lot of anomalies that were incompatible with life," Dr Thomas said. Fetima Tinggar and Kevin Mitial travelled with their twins on the plane to hospital in Sydney. (Supplied: Manolos Aviation) Special equipment was used to help Tom and Sawong on the plane to Sydney. (Supplied: Manolos Aviation) "We saw a little baby who had a very good chance of survival, provided we could do a safe separation," Dr Thomas said. "And we knew that if we didn't separate them, both would die." The news brought a complex mixture of relief and devastation to the boy's parents, Fetima and Kevin Mitiam, but they agreed to transfer the twins to Sydney. After days of meticulous planning, a small LifeFlight plane landed in Port Moresby to collect Tom and Sawong. Tracey Lutz, a retrieval specialist and neonatologist, said it was not a typical airlift. "It was always going to be a challenging mission because of the distance," Dr Lutz said. "It took us over five hours out-of-hospital time." Gordon Thomas is a paediatric transplant surgeon who worked on the PNG twins. (ABC News: Scott Preston) Tracey Lutz is a neonatologist and retrieval specialist who worked on the twins. (ABC News: Scott Preston) That meant the team needed to be equipped to manage any possible deterioration in either twin's condition. "I had to think about them in that way, not as an individual baby, but also as affecting each other," Dr Lutz said. Even the cabin pressure in the plane had to be adjusted to make sure Tom's breathing difficulties weren't exacerbated during the flight. When Tom and Sawong finally arrived at the Children's Hospital, Westmead, things were worse than the doctors thought. "We actually discovered that we didn't have much time at all … we had to do an urgent separation," Dr Thomas said. The marathon surgery took eight hours and involved five different specialist surgeons, a large team of anaesthetists, surgical

Doctors reveal complex, multi-country mission to help conjoined twins

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