Plan for separation of conjoined Indian twins stirs debate (Feature)

By Kai Portmann Jun 16, 2009, 4:50 GMT

   Singapore - For Vani and Veena separation would be a relief. Born to landless labourers in the Indian state Andhra Pradesh, the 5-year-old twin sisters are conjoined at the head.

   Fused together at the skull, even walking is painful for Vani and Veena as their heads move in grotesque-looking contortions.

   But Vani and Veena may get a chance to live a new life later this year.

   Requested by the Andhra Pradesh government, renowned Singapore neurosurgeon Keith Goh - who was involved in the surgery of Nepalese twins Ganga and Jamuna in 2001, and in the unsuccessful operation of 29-year-old Iranian twins Ladan and Laleh in 2003 - has agreed in principle to separate the twins in the city-state.

   'I am ready to carry out further tests on the twins, to determine the feasibility of surgery and the associated risks and potential complications,' said Goh, stressing that he is not able to confirm any surgery right now.

   But Goh's announcement to consider an operation of Vani and Veena alone stirred a dispute in Singapore.

   Health Minister Khaw Boon Wan cautioned against a surgery of the twins, who are under the care of Niloufer Children's Hospital in India's Hyderabad.

   'Surgeons, in some instances, have to pick one twin to die to save the other,' the minister said in remarks carried by the Straits Times newspaper.

   'Even those who survived would often be left with brain damage. So, to what extent is this quality of life,' he asked.

   'To change the course of nature may do more harm than good,' Khaw argued.

   His remarks resonated in internet forums. 'I think minister Khaw is right. The operation is too risky,' read one comment.

   'There (is) so much to do in Singapore for Singaporeans,' read another. 'Why are we wasting time, energy and money over a show-off operation just to get a particular surgeon into the limelight?'

   Others supported Goh and questioned the minister's argument that it might be wiser not to interfere with nature.

   'If that is true, then all doctors should just lay back and relax and let people with heart disease, cancer, brain tumours, deform(ed) limbs (or) cleft lips go on with their miserable lives,' said one.

   Singapore's community of health professionals has kept silent, at least in public.

   The National Neuroscience Institute rejected a request to give an opinion on surgery of conjoined twins in general, saying it 'will not be commenting on this matter.'

   Other physicians didn't respond to e-mails asking for comment.

   'Singapore is a small place,' said one doctor who preferred not to be named, trying to justify the reservation of the city-state's medical profession.

   'Such cases are bound to attract controversy and differences of opinions,' said Goh, currently consultant neurosurgeon and medical director of the neurosurgery centre at East Shore Hospital.

   'My personal belief as a doctor is that when patients with clinical problems ask for help to correct or improve their condition, we should see if we can help them,' he added.

   It was a doctor's duty to disclose the risks of a treatment and then leave it to the patient or their family to decide.

   The biggest challenge for the surgery of Vani and Veena was to understand the physiology of the cerebral blood flow between the conjoined brains. Another crucial point was the reconstruction of the scalp defect after separation.

   'I would estimate that the twins have a greater than 50 per cent chance of surviving the operation, but the quality of survival may not be perfect,' Goh said.

   Like Nepalese twins Ganga and Jamuna in 2001, Vani and Veena might suffer from neurologic deficits, such as paralysis, speech and cognitive problems after separation.

   The estimated costs for surgery and treatment come up to about 750,000 Singapore dollars (514,000 US dollars) which the Andhra Pradesh government would be expected to fund.

The parents of Vani and Veena agreed to the surgery, but Goh said he was still awaiting a final decision from the state government.