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Inside story of separation of Bayelsa conjoined twins

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By Duku Joel

  • COVID-19 nearly frustrated process, says lead surgeon
  • Why it took only three hours to conclude operation

In December 12, 2019, a young woman went into labour at the Nembe General Hospital in Bayelsa State. As young couples who were expecting their first child, they were in high spirits as they prepared to welcome their bundle of joy, particularly as the scan earlier conducted on the pregnancy had revealed that the woman would be delivered of twins.

There was, however, a twist to the story when the unemployed secondary school leaver, Godsgift Ibiyyefa, was operated upon only to be delivered of a set of conjoined twins. The shock and disappointment that stared in the face caused her to faint immediately.

“When I was told that the babies were conjoined twins after I had undergone an operation, I was scared and I fainted,” she said.

But her hope was rekindled with the news of a possible solution to the dire condition of her babies after she was revived.

Godsgift might have gone into coma, but not her husband, Raphael Ayebaiemi, who works as an okada (commercial motorcycle) operator. But while Ayebaiemi’s faith was unshaken by the unseemly sight that confronted him, he could not help wondering how he would muster the funds needed for a surgical operation that would separate the conjoined twins.

By what magic, he wondered, would a poor okada rider like him fund an operation that would cost millions of naira and still fend for the family in this season of serious economic crunch?

Looking back now, the 27-year-old secondary school leaver has nothing else to do than give thanks for the divine intervention that saw her conjoined lovely babies successfully separated at the Federal Medical Centre in faraway Yola, Adamawa State.

“It was a miracle, and I give God Almighty the glory,” he said.

Asked whether he lost hope at any point about the separation and survival of the babies, Ayebaiemi said: “I was never hopeless. All I was thinking was how to get the money needed for the separation. But I know that God has a purpose for doing anything, so I knew there was a reason for this to happen,” he said.

From Yenagoa to Yola

In spite of the ultra sound scan that was done on the pregnancy, the much it could reveal was that Godsgift was pregnant with twins. The fact that they were Siamese twins was not revealed.

So, immediately they were delivered at the General Hospital in Nembe, doctor wasted no time referring them to the Federal Medical Centre (FMC) Yenagoa, according to the lead surgeon and Chief Medical Director of the medical centre, Prof. Auwal Mohammed Abubakar, who presented a situation report on the operation.

Upon arrival at the FMC Yenagoa, the babies were carefully managed and stabilised within the first 28 days, which, according to child development process, are very critical, as the babies had to be kept warm to prevent infection.

According to Prof Abubakar, the management of Federal Medical Centre Yenegoa contacted them at the FMC in Yola where they also expressed the willingness to receive the babies.

With the FMC Yola agreeing to receive the babies, the challenge became how to transport them from Yenagoa to Yola. It was a task that almost frustrated the entire process.

Abubakar said: “Moving the children on the road was a difficult option because of the civil strife on the highways. The option of a commercial flight was so expensive and would attract undue attention and pose psychological problems to the family of the babies. Using an air-ambulance was completely out of reach and out of the options.”

However, with just one phone call to the Air Force, the Chief of Air Staff, Air Mashal Sadiq Abubakar, approved the airlifting of the babies with the parents and three other medical personnel—a neonatologist, a pediatric surgeon and a nurse from FMC Yenegoa—who accompanied them to Yola on January 4, 2020 when the conjoined twins were 23 days old.

The COVID-19 challenge

The babies, according to Prof. Abubakar, were scheduled for separation when they were between three and four months old, but the entire process was put on hold by the outbreak of the COVID-19 pandemic.

He noted that while the pandemic and the consequent lockdown lasted, his team seized the opportunity to carry out more precise investigations to determine if the babies did not share major body organs.

Abubakar also explained that the outbreak of the pandemic in Nigeria also made it difficult to activate the surgical team from different locations for fear of transporting the virus from different locations to Yola or taking it from Yola to other places.

He said: “We activated the team in July but it didn’t work. We also picked August 10, 2020 but again because of COVID-19, we still had issues. We had other members of the team from other parts of the country, including the University of Maiduguri Teaching Hospital, Federal Medical Centre Gombe and also a professor of Anesthesia from Ife (Obafemi Awolowo University).”

To find a way out of the problem, the team had to embark on virtual meetings for debriefing until finally they agreed to carry out the surgery on the 10th August, 2020. He added that all COVID-19 protocols were observed during the operation through live projection.

“We had a live projection of the separation to our conference room downstairs. Members of the team were called to the theatre any time their attention was needed,” he said.

Happily, he said, no member of the team had so far manifested any symptoms of the virus three weeks after the operation.

Duration of operation

Although the operation lasted three hours, it did not pull through within such a short time without certain challenges involving human management, modern technology and the less complicated nature of the conjoined.

According to the lead surgeon, Abubakar, having previously worked together as a team in separating five conjoined twins (two at the University of Maiduguri Teaching Hospital and three in Yola) made the work of the team easier.

Abubakar said that from past experience, most of the members of the team knew exactly what was required of them, which he noted had a very significant impact on time management and proficiency.

He also said that technology and modern equipment contributed in no small measure in managing organ separation and blood loss during the operation.

He said: “Experience and technology prevented a waste of time in this operation. It lasted only three hours. This is something we have been doing as a team for a very long time. So, that helped a lot.

“The use of modern equipment also helped. The contribution of the machine we got from Nigeria Liquefied Natural Gas (NLNG) and the Sir Emeka Offor Foundation helped in the division of the liver, because the babies had only one liver. That reduced the amount of blood lost and the division was more precise.

“Another important thing to note is the nature of the conjoining. This one was less problematic as they had separate organs except their liver. So the duration for the operation was less.

“Don’t forget that some separation can last five days or more, depending on the nature of the conjoining.”

Recovery process of separated twins

The recovery process of the separated twins, Grace and Mercy, was very rapid and speedy.

According to Abubakar, the recovery rate of the babies was dramatic as they were discharged from the Intensive Care Unit (ICU) three days after operation, and within five days, they had started playing and were discharged to residential.

SGF excited with operation in home state

During the unveiling of the conjoined twins at an elaborate event held at the premises of FMC Yola, the Secretary to the Government of the Federation, Mr. Boss Mustapha, who was the Special Guest of Honor at the occasion, expressed his excitement over the successful separation of the babies at a medical facility in his home state of Adamawa.

He said: “When I saw on the national network news the evacuation of these twins, Mercy and Grace (what a wonderful set of names) being flown all the way from Yanegoa to Yola, as an indigene Adamawa State and a true son of Yola, the first feeling I had was a sense of pride that in spite of our being stuck at the boundary with the Cameroon, we still have enough to offer this nation.

“If not, why transport these girls from the coast of the Atlantic to a distance of over an hour, crossing major states and cities, only to be brought to Yola for medical attention?”

Mustapha also extolled the sterling medical feat of Prof. Abubakar with respect to five successful separations of conjoined twins in his career and still counting.

The SGF promised to do everything in his capacity to uplift the standard of FMC Yola into a world class medical centre of competitive standard.

He said: “Doing this exercise for the fifth time is not a mean feat. It is not a joke. It requires diligence, precision, application of intellect and the management of men and resources. Prof. Auwal, you have demonstrated that.

“On behalf of the President, I must thank you and your team for doing this over and over again. I believe FMC Yola will take the spotlight.

“We will not lose the opportunity of the moment. We will do everything to ensure that all the necessary support that you require to build an edifice that will compete internationally in terms of the provision of medical services is attained in Federal Medical Centre, Yola.”

He also praised the intervention of the Nigerian Air Force for evacuating the babies from Bayelsa to Adamawa and back to Bayelsa after a successful operation.

“It’s my personal delight and honour to be invited to be the special guest of honour. Today, FMC Yola is recording another milestone.

“I truly want to commend the Medical Director, Prof Abubakar, for yet achieving another feat in the separation of these conjoined twins that came all the way from Bayelsa, the Niger Delta,” he said.

Mustapha described the operation of the babies in Yola as a unique demonstration of the bond that Nigerians share in spite of differences in ethnic backgrounds, creed and beliefs.

He commended the Chief of Air Staff for deploying his official aircraft to airlift the babies from Yenagoa to Yola.

Show of love for twins

It was indeed a red carpet treatment and huge show of love for Grace and Mercy as they were set for their journey back to their home town in Nembe, Bayelsa State after staying almost eight months in Yola for their operation.

Members of the hospital community, the medical staff and dignitaries struggled to outdo one another for group and individual pictures with the babies after their unveiling at the Federal Medical Centre Yola.

After the group picture with the Special Guest of Honour, Mr. Boss Mustapha, the Chief of Staff to Adamawa State governor, Prof. Maxwell Gidado and other dignitaries, the babies were almost missing in the arena as they kept moving to different groups and individuals who never wanted to miss the chance of photographs with the babies.

Our correspondent observed that the photo extravaganza had to be abruptly ended to enable Grace and Mercy embark on their journey back to the Niger Delta as the Air Force plane was waiting to fly them home.

Appreciation, appeal for support

The father of the babies, Raphael Ayebaiemi, fought back tears of joy as he thanked everyone who contributed to the successful operation on his babies.

He said: “I am grateful to the Chief Medical Director of FMC Yola Prof. Auwal Abubakar, and the management and staff of Federal Medical Centre Yola for all that they have done for me and my family in separating these babies.

“I did not pay a dime for the operation, and since we came to Yola, the hospital has been taking very good care of us, my wife and children.

“I thank the Nigerian Air Force for bringing us to Yola for the operation. Left for me alone, I would not have made it. I understand that they are taking us back to Bayelsa and I can’t thank them enough.”

He, however, appealed for further support in taking care of the babies, saying that he is only an okada (commercial motorcycle) operator, while his wife is a complete housewife.

He said that both of them are secondary school leavers who would have loved to further their education to enhance their standard of living.

He said: “My major priority right now is not even about me, but for me to be able to take care of these children so that they can become better people tomorrow.

“I am appealing to my state, Bayelsa, and the Federal Government and any individual to come to my aid so as to enable me take care of my children.

“I am just an okada rider and my wife does not have any work, so it will be difficult for us.

“I hope to further my education, but the arrival of these children now is a problem.”

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