The two of us

Updated

It took an army of Australians to separate conjoined twins Nima and Dawa. Now the toddlers are reunited with their whole family in a spectacular Himalayan homecoming.

The plane carrying Bhumchu Zangmo and her twin daughters, Nima and Dawa, banked left and right moments before it touched down smoothly on the runway of one of the most dangerous airports in the world, high in the Himalayas, in Bhutan.

Nervously waiting for them was Sonam Tshering, the twins' father. The last time he saw his daughters, now 20 months old, they were conjoined, fused together from the lower chest to the abdomen.

Bhutanese people are normally not known to show emotions in public but Sonam admits, "I didn't sleep at all last night".

He wears the traditional Bhutanese robe, secured with a belt, for the homecoming. With him is the eldest of his six children, Ugyen Choden, 18, plus more than a dozen friends and family ready to welcome the twins home.

They seem oblivious to the growing crowd as they take photos of each other to commemorate the day and prepare metres of long, white diaphanous scarves, a traditional symbol of purity in the deeply Buddhist kingdom, to wrap around their returning family members.

Then the whole airport stops as Bhumchu disembarks, carrying Nima and Dawa together — as if still joined — across the tarmac, past a wall of photographers and a cheer squad of customs officials who waive all the rules and wave them through towards Sonam.

In all the noise, Sonam gingerly approaches his wife and daughters and presses his face close to theirs. He wraps them close with a scarf, purifying them in their first moments back home. Later the family will visit a temple, as all Bhutanese people do when they've been away.

But first, the reunited family are swamped by more than 100 people draping them in layers and layers of pure white.

It was a hero's welcome for twins Nima and Dawa, who were largely hidden and unknown in Bhutan until they left for Australia.

Conjoined twins 'a big shock for everyone'

It was considered a standard pregnancy with twins when Bhumchu underwent a caesarean section at a regional hospital in Phuntsholing, Bhutan.

Dr Karma Sherub is the sole trained paediatric surgeon in the country and was one of the first people to meet the twins.

"As they pulled out one baby, the other one came attached to it," he says. "It was a big shock for everyone."

The babies were bundled up and driven five hours to the Bhutanese capital of Thimphu, escorted by their father Sonam, and into the care of Dr Karma.

Bhumchu arrived the following day, still unaware of her babies' condition.

"We had to break the news to her that her babies were joined together," Dr Karma says. "Like all of us, she was really surprised, she had never imagined anything of this sort."

Both parents were in a state of stunned disbelief. These were Bhutan's first conjoined twins in living memory.

"When I first saw my babies, I didn't know how to feel," mother Bhumchu says. "I didn't know if I should feel happy or sad. I was so worried for them."

Sonam was bewildered. "I thought it was a curse," he says. "I was very disturbed and I didn't know what to do."

No one knew what to do. Dr Karma had only ever read about the condition. So he reached out to a colleague in Melbourne for help.

Trial of life

Associate Professor Chris Kimber, a paediatric surgeon from Monash Children's Hospital, looked at the first images and scans of the twins sent to him from Bhutan.

On the outside, Nima and Dawa were fused together from the lower chest to the abdomen.

Inside, though, was somewhat of a mystery.

It appeared the livers were joined, but the rest was unclear.

"We have to be very cautious with these twins because once you have an anomaly like that, there may well be several other anomalies that you don't know about," he says.

"The last thing that you want to do is to rush any sort of surgical approach."

Nima and Dawa were born otherwise healthy so it was decided the next best course of action was for them to return home and undergo a trial of life.

In other words, do nothing and wait to see what happens.

It takes a village

Over the first few months, doctors were delighted with the twins' progress.

However, Associate Professor Kimber says there was no question the twins needed to be separated.

"We felt it was unlikely that they could walk normally, grow normally and learn normally and function as individuals without that separation," Associate Professor Kimber says.

He contacted the Children First Foundation, a charity that brings to Australia children who need complex and life-changing surgery that cannot be performed in their own country.

Ten years ago, Children First Foundation brought Bangladeshi conjoined twins Trishna and Krishna to Australia for successful separation.

They began the protracted process of raising funds, contacting their vast network of surgeons and hospitals, and calling in favours to climb a mountain of bureaucratic paperwork to provide the same life-changing opportunity for Nima and Dawa.

The sun and the moon

Nima, meaning sun, and Dawa, meaning moon, are the names given to every twin born in Bhutan.

After a few months, the sun and moon twins started to move.

Very early on, Nima showed her dominance over the more placid Dawa by jostling for top position. Literally. Dawa was routinely crushed beneath her sister.

Life for Nima and Dawa was doubly confining. The family's fear of social stigma kept the twins concealed indoors and away from the stares of strangers.

"Our family felt hesitant to expose the twins to the outside world," Bhumchu says. "We feared what people might think. People might be quite negative about such unique human beings."

Then, when the girls were about 10 months old, their condition began to deteriorate. They were losing weight. They began scratching and kicking one another and had lesions on their faces and arms.

"While one was sleeping, one was awake and biting the other child," father Sonam says.

Associate Professor Kimber visited Bhutan and checked in on the twins.

"They seemed to be very sick infants," he says. "I realised that now was the time to get them to Melbourne for surgery."

Highwire operation

On November 9, 2018, at the Royal Children's Hospital Melbourne, a team of 35 medicos including specialist surgeons, nurses, and anaesthetists are prepping for surgery. More sophisticated scans show the twins' livers are joined, possibly some bowel.

But doctors don't know exactly what to expect until Nima and Dawa's tiny bodies are opened up.

The day before the surgery is spent in a full dress rehearsal, workshopping a range of possibilities.

Head paediatric surgeon Joe Crameri leads the team planning.

"The worst-case scenario is that we go in there and we can't separate the twins," he says.

When the time comes for the girls to be sent into surgery, Bhumchu leans down over the metal hospital trolley.

She whispers a soothing prayer to her twin daughters and chokes back a sob as they are wheeled away from her and into an unknown future in the operating theatre.

She doesn't know if she will see both or either child alive again.

Nima and Dawa are sedated but aware. They stare up at the gowned men standing over them. They are anaesthetists, preparing for the first big challenge of the day. Putting to sleep two individuals who also share parts of their body.

"We've got arms and legs and trunk and head going in all sorts of directions," anaesthetist Ian McKenzie says.

Once the anaesthetists are satisfied, the surgeons move in.

Nima and Dawa are opened at their join, their internal connections exposed. The surgeons methodically examine each organ and a sense of relief floods the theatre.

They find the girls' livers are joined but in a way that can be divided safely.

At the moment of separation, one of the girls is cradled and lifted carefully onto her own operating table. As one patient becomes two, there is still more work to be done.

The second stage of the operation is repairing the damage caused by the separation surgery.

"I knew one of the bigger challenges wasn't getting them apart, the bigger challenge was getting them back together as two individuals," Mr Crameri says.

Two separate surgical teams, working side by side, then begin to rebuild the front of each girl's body.

Incredibly, the operation is completed two hours ahead of schedule.

Mr Crameri almost bounces into a waiting room, flanked by Dr Karma, to deliver the good news to Bhumchu.

She leans forward, bowing respectfully, her hands clasped. Overwhelming relief shines on her face.

"After hearing the surgery was successful, I was so happy," Bhumchu says. "I was so eager to see the kids face to face."

When Nima and Dawa wake from their life-changing surgery, they find themselves alone for the first time ever.

It soon becomes obvious they are distressed being apart so they are quickly placed together in the same cot, where they settle immediately, in contented close company.

Hitting milestones

Over the past four months since their operation, Nima and Dawa have hit some development milestones.

At their home away from home at the Children First Foundation retreat in Kilmore, an hour north of Melbourne, volunteer physiotherapist Katie Hatton has been putting them through their paces.

"Our goal would be ideally to get them walking as soon as possible," she says.

Watching The Wiggles has turned out to be a great motivator.

To the tune of "mashed banana, mashed banana" the twins have learned to crawl, pull themselves up and stand. They're toddling with a helping hand. They're even learning some English. "Happy. Mum."

There have been about 50 Children First staff and volunteers who have contributed to Nima and Dawa's new lives.

Earlier this month, about half a dozen volunteers and staff accompanied the family to Melbourne Airport for the start of their journey home.

They play peekaboo, blow kisses, hug, smile and joke around with the twins. They do anything but cry, as they wave them goodbye.

Chief executive officer Elizabeth Lodge says they will miss the girls. "When all the children go home there is that bittersweet sense that we feel," she says. "We love them when they're here and we send them home with hope in our hearts."

A Himalayan homecoming

Three days after touching down in Bhutan, after all the official celebrations and medical checks with Dr Karma are over, Nima and Dawa are reunited with their other three siblings at home in Phuntsoling.

Their eldest sister, Ugyen Choden, beams with joy as the twins independently toddle behind on the grass, Nima going one way and Dawa the other.

"It is the happiest moment ever in my life," she says.

The family drink tea and soak up each other's company after so many months apart.

All eyes are on the twins, who seem to have gotten used to being in the spotlight.

Nima offers her father a piece of fruit.

"Orange," she tells him in English.

"Orange!" they all chorus back in delight.

Watch Australian Story's It Takes a Village on ABC iview or Youtube.

Credits:

Photography: Marc Smith, Herald Sun's Alex Coppel, Belinda Hawkins, Vanessa Gorman

Sub-editor: Rosanne Barrett

Digital producer: Megan Mackander

Topics: children---toddlers, medical-procedures, human-interest, melbourne-3000, bhutan

First posted