The Liver Between

THE twins, Bupe and Mapalo before their separation. PICTURE: JACK ZIMBA

IT WAS a story that captivated the nation when it broke eight months ago – the birth of Siamese twins to a poor couple in Kawambwa, Luapula Province.

The two sisters, named Bupe and Mapalo, born to Moses and Lydia Mwape, were joined at the abdomen, facing each other and were delivered through caesarian section.

Months following their birth, the nation anxiously waited for the operation to separate the twins.
On Friday, Mapalo and Bupe were wheeled into the theatre room.
The operation was conducted on the first floor of the D Block at the University Teaching Hospital.
A cable ran from the theatre room down the corridor and connected to a huge TV screen in a room where a group of hospital staff monitored the procedure in real time, their kind of “situation room”.
A little further away from the situation room was the press room packed with a dozen or more journalists anxiously waiting for up-dates.
A block away, in a secluded place, the parents of the Siamese twins waited, being offered emotional support by counsellors, as they also received updates on the operation.
For the hospital, it was history in the making, and for the journalist it was a rare moment to capture history.
Siamese twins are extremely rare – about 1 in 49,000 births to 1 in 189,000 births, with a somewhat higher incidence in south-east Asia and Africa, according to the online encyclopedia, Wikipedia.
The last time the country had a similar case was in 1997 when two boys were born to a couple in Lusaka, their heads attached at the top of their heads. The boys, named Luka and Joseph Banda, were separated at Ga-Rankuwa Hospital in Pretoria, South Africa.
The operating team was led by neurosurgeon Ben Carson, the eminent American doctor and author, now turned politician.
Dr Carson had previously been contacted by the Pretoria hospital because of his documented success in operating on Siamese twins, although his first attempt to separate sisters Nthabiseng and Mahlatse Makwaeba in 1994 at the hospital was not successful; both girls died hours after their operation.
Dr Carson says in his book, The Big Picture, that when he was contacted to help separate another set of twins born in Zambia at the Ga-Rankuwa Hospital, he was hesitant, not wanting to experience another failure. He finally agreed.
Zambia’s neurosurgeon, Dr Tackson Lambert, was also part of the team that operated on Luka and Joseph in an operation that lasted 20 hours.
The boys are still alive today.
Twenty-one years on, the country’s largest health facility was at the precipice of making its own history.
The leading surgeon was Dr Bruce Bvulani, until now a little-known figure to the public.
The 27-member team had also relied on the experience of very experienced surgeons, including Dr Lambert, Prof Lupando Munkonge, among others.
As is usually the case in operations separating Siamese twins, there were two teams of surgeons and other support staff.
This is so because after the separation, each twin has to be worked on immediately.
After an anxious moment that seemed to last forever, there were rounds of applause at 16:57 hours from the situation room. It was like cheering a soccer march.
For the journalists, who were kept in the dark most of the time, it was an anxious moment to get the news.
But as is usually the case nowadays, the big story of the conjoined twins could not escape the fake news phenomenon.
Two hours into the operation, an irresponsible reporter from a local TV station reported that the twins had been successfully separated.
However, a few minutes after 17:00 hours, the jubilation in the situation room was confirmed by Dr Maureen Chisembele, who is superintendent for the Women and New-Born Hospital.
She gave a terse statement saying the operation had been successful, and gave the exact time of the separation as 16:58 hours.
It was a moon-landing moment for the hospital staff in the situation room when the operation was over around 18:30 hours. There were hugs, handshakes and praises to God.
Two female doctors and a nurse danced frivolously like little girls down the corridor.
“I was so anxious when it started but now I’m happy. God has made it for us. It has been a long journey,” said Dr Mala Marie, who was monitoring the procedure from the large screen in the situation room.
“It is the first time to witness such an operation,” she said.
When the first twin was wheeled out of theatre at 18:35 hours, she was welcomed by a jubilant crowd and was followed all the way to the intensive care unit (ICU) by a crowd of excited medical staff and reporters.
A security officer at the entrance of the ICU stood erect and gave a salute as the theatre bed bearing one of the twins rolled by.
At 18:48 hours, the second twin was wheeled out of theatre and was greeted with the same euphoria.
As the doctors walked down the long corridors to the ICU, they were treated like war heroes returning from battle, but their response was rather restrained. Either they were too tired to join in the jubilation or they were being cautious.
They held a brief press conference outside the ICU, but were clearly not willing to answer many questions.
“The surgery went well. We successfully separated the twins and we are now just waiting for them to recover,” said Dr Bruce Bvulani.
He thanked everyone involved in the operation.
Dr Bvulani said the team was happy with the outcome of the operation.
He said the major fear for the team was that the twins shared a liver but it was discovered that the two livers were only attached.
According to Dr Bvulani, the biggest challenge during the operation was to keep the babies under anesthesia.
“The fact that you are putting two people to sleep at the same time; that really is the biggest challenge. If you can do that successfully, then the other part of the surgery becomes easier,” he said.
And the anesthetic team, led by Dr Christopher Chanda, was up to the challenge,.
After the operation, father of the twins was full of appreciation.
“We thank you all, you have kept us well from the time we came to Lusaka for the operation. You (journalists) have been here since morning until this time of the night and we thank you for that. We do not have much to say apart from asking God to bless you and the medical staff,” said Mr Mwape.
Mother, Lydia, could not hide her joy and gratefulness to God.
“I thank God for what he has done. Lesa Mukulu elo aba mubantu,”she said.
One surgeon who had witnessed the operation described it as “extremely successful”.
For some among the medical staff, however, there was cautious celebration.
“For us the job has just begun,” remarked a nurse as she scurried to the ICU, gadgets in hand.
If world renowned novelist Ngũgĩ wa Thiong'o had lived up to this day, he would probably have considered writing a book “The Liver Between”, from his famous The River Between


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