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Stuti (left) and Aradhana after surgery (Photo by SCN News)

Miracle surgery

Medicine | Success and sadness proceed from dramatic decision to separate conjoined twins, abandoned by their parents, at a 122-year-old mission hospital in India's central highlands

Issue: "Praying for rain," Aug. 11, 2012

Thirty years after graduating from Christian Medical College (CMC) in Vellore, India, six medical school classmates and their teacher had an unlikely reunion in June. At the request of classmate Rajiv Choudhrie, medical superintendent of Padhar Hospital, a 122-year-old mission hospital in rural Betul, they came together to write medical history: Their team plus 16 other doctors from India and Australia would attempt to separate a pair of conjoined twin girls, an operation never before completed in rural India.

For 12 hours, the surgical team bent over 1-year-olds Stuti and Aradhana, carefully cutting the tissue joining their chest and abdomen together. They saw abnormal anatomy-two hearts stacked on top of each other in a common pericardial sac, each beating at its own rate. A good amount of Stuti's blood was flowing through her sister's body.

They separated the hearts and created two sacs from the existing one, placing a heart into each girl. They then divided the liver, which had two separate blood supplies but were joined by a bridge of liver tissue. Then, with the cutting of the sternum and the closing of the wound, the surgery was complete.

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Everyone in the hospital cheered at the successful operation, which many had decried as an impossible medical operation for the mission hospital. For the staff, the successful surgery was much more personal than proving a point: Stuti and Aradhana had become like their own children.

The girls, whose names mean "praise" and "worship" in Hindi, first came to Padhar last May, when their mother was pregnant. She had trouble delivering them at a government hospital, so they sent her to Padhar. During the Caesarian section, the obstetrician jumped back when she realized that the twins were attached at the chest. The young parents felt overwhelmed and unable to care for the girls, and "donated" them to the hospital.

From then on, Choudhrie's wife, Deepa, a 1982 CMC Vellore grad and a radiologist, took on the dual role of mother and doctor for the girls. A number of the nurses and staff also quickly grew attached to the girls, often coming in after hours to play with them.

Despite being conjoined, the girls each developed their separate personalities. "Aradhana, I think, is quicker to smile," Choudhrie said. "Stuti would look at you and wonder whether you were worthy of her smile." Stuti was thinner, while Aradhana was taller and plumper.

The media descended on the hospital, wanting to get pictures and videos of the twins. But the Choudhries and hospital staff worked to protect the girls from the hovering eye of the media: "These are not freaks, this is not a circus. These are humans beings, for us they were God's creation."

Padhar Hospital's decision to spend so much time, money, and energy to save two abandoned girls was news itself. Padhar first opened in 1890 and is affiliated with the Evangelical Lutheran Church in Madhya Pradesh, located in India's central highlands. Its rural site seemed an unlikely place for groundbreaking surgery, but the hospital has a long history of treating polio and AIDS, and of providing dialysis and other specialized services. Recently Padhar has worked with Smile Train to perform cleft lip and palate surgeries.

Another factor weighing on hospital staff: The girls were born right as the national census revealed a serious demographic crisis-for every 1,000 boys under the age of 6, there were only 914 girls. In the past decade, parents have aborted between 3 million and 6 million baby girls, as women are seen as merely a financial burden on the family.

The state's chief minister, Shivraj Singh Chouhan, hoped to reverse the trend by launching a program that provided girls aid for education and food. He was a big supporter of Stuti and Aradhana, donating to the surgery and later visiting them on their first birthday.

From the beginning, the doctors discussed whether separation was viable for the girls. Without the operation, the girls would never lead normal lives and the risk of death was high-if one girl got sick and died, the other would die as well.

Once scans revealed that each of the girls had her own set of internal organs and could be separated, Choudhrie called on his old classmates for help. He contacted Gordon Thomas, a pediatric liver transplant surgeon in Sydney; Sanjeeth Peter, a heart surgeon; Anil Kuruvilla, the head of neonatology at CMC Vellore; and their former anesthesiology professor, Rebecca Jacob. Choudhrie also contacted psychiatrist Prabahkar Thyagarajan to try to reunite the girls with their family.

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