SUDANESE JOURNAL OF PAEDIATRICS

2023; Vol 23, Issue No. 2

EDITORIAL

The engraved code of professionalism and ethics: Story of Sudanese conjoined twins

Mustafa Abdalla M. Salih (1), Mohammed Osman Swar (2)

(1) International Editor, Sudanese Journal of Paediatrics, Khartoum, Sudan

(2) Editor-in-Chief, Sudanese Journal of Paediatrics, Khartoum, Sudan

How to cite this article:

Salih MAM, Swar MO. The engraved code of professionalism and ethics: Story of Sudanese conjoined twins. Sudan J Paediatr. 2023;23(2):109–111.

https://doi.org/10.24911/SJP.106-1703620501

This issue of the Sudanese Journal of Paediatrics (SJP) has been contributed to by authors from eight countries belonging to three continents. It includes articles that cover COVID-19 and other infectious diseases, community health and medical education, nutrition, endocrinology, neurology, genetics, haematology, oncology and cardiology.

The section on Historic Perspectives highlights the story of the famous Sudanese conjoined twins, Hassan and Hussein narrated by their maternal uncle Dr. Yousif Eshag Omer Elhaj, who works as a consultant paediatrician [1]. Born 37 years ago (August 1986), their story represents the generosity of humanity, miraculous surgery, as well as medical professionalism and ethics in their prime.

When labour began, their mother Fayza (who lived in Kosti, located 259 km south of Sudan’s capital Khartoum) was taken to hospital. The treating physician was then Dr. Moawia Elsadig Hummeida (currently professor of obstetrics and gynaecology, Al-Neelain University College of Medicine) [2]. Since it was an obstructed labour, she was hurriedly taken to Rabak Hospital for an emergency caesarean section in an open-top Toyota pick-up truck accompanied by Dr. Moawia who paid for the transport. The distance from Kosti to Rabak is 9 km, but the road was muddy and the rain was pouring. To complicate things, there was a power cut in Rabak Hospital and the caesarean section had to be done using handheld torches!

The caesarean section revealed the unexpected, twins joined from chest to hip. Dr. Moawia, who has been a classmate of one of us (Mustafa Salih[MS]) during elementary school, brought a photograph of the conjoined twins to him at the Department of Paediatrics and Child Health, University of Khartoum (U of K) Faculty of Medicine, for consultation. They were admitted to Soba University Hospital (the teaching hospital for the U of K Faculty of Medicine) under the care of the late paediatric surgeon Dr. Ibrahim Abdelaziz (who established the first paediatric surgery specialty in Sudan [3,4]).

After a few days, the father of the twins relayed to MS that he was uncomfortable regarding the idea of sacrificing one of the twins who was getting weaker and saving the other (an established ethical dilemma in conjoined twins surgery [5]), and is aspiring to save both of them. MS advised him to send the photograph of the twins to be shown to the late monarch of Saudi Arabia His Majesty King Fahd bin Abdul Alaziz. Ironically, at that time, MS was writing a medical report, in reply to the Saudi Royal Court, which was brought to him by a family regarding a Sudanese child with cerebral palsy who was considered for the Royal sponsorship to be treated in Saudi Arabia.

Figure 1. The conjoined twins Hassan and Hussein holding a traditional Sudanese food tray cover made of coloured date palm tree thatch. Their photograph before surgical separation is mounted on the tray (below) and another photograph with the surgeon Professor Lewis Spitz (above).

Communications in Saudi Arabia were done by the uncle of the twins, Dr. Yousif Eshag who was working at King Saud Medical City, also known as Shemaisi Hospital, in Riyadh. These resulted in the humane and generous Royal Decree to sponsor the treatment of the twins in London, accompanied by their parents. Dr. Yousif Eshag joined the family to communicate on their behalf and handle their affairs. Surgery was done by Professor Lewis Spitz, and they were the first conjoined twins to be separated in the UK [6].

The twins have stayed in the UK with their family, within easy reach of the medical care that they still require (Figure 1). Both accomplished university degrees.

The SJP has highlighted previously the story of Rital and Ritaj, the Sudanese craniopagus conjoined twins who were born and had their early neonatal management at Soba University Hospital, Khartoum [7,8]. Through the BBC, the girls’ parents, who are both doctors, contacted the charity organisation “Facing the World” which arranged the transfer of the twins to the United Kingdom with their parents, and organised all the logistics and paid for the surgery [9]. Eight years later, they were reunited with the British doctors who saved their lives and expressed their sincere gratitude [10].

The humane contribution of the Kingdom of Saudi Arabia should also be credited. Since its launch in 1990, Saudi Arabia’s Conjoined Twins Program has treated more than 130 cases from countries around the world, paving the way for several conjoined twins from different nationalities including Sudanese to lead a normal life. Ironically, the Tanzanian conjoined twins who were separated in October 2023 are named Hassan and Hussein! [11].

REFERENCES

1. Elhaj YEO. The story of the Sudanese conjoined twins, Hassan and Hussein. Sudan J Paediatr. 2023;23(2):XXX. https://doi.org/10.24911/SJP..........
2. Moawia Elsadig Hummeida. [cited 2023 Dec 22]. Available from: https://www.researchgate.net/profile/Moawia-Hummeida
3. Aziz IA. Hydrocephalus in the Sudan. J R Coll Surg Edinb. 1976 Jul;21(4):222–4. PMID: 966194.
4. Aziz IA. Neural tube defects in the Sudan. J R Coll Surg Edinb. 1983 May;28(3):151–3. PMID: 6875984.
5. Thomas A, Johnson K, Placencia FX. An ethically-justifiable, practical approach to decision-making surrounding conjoined-twin separation. Semin Perinatol. 2018 Oct;42(6):381–5. https://doi.org/10.1053/j.semperi.2018.07.016. Epub 2018 Jul 26. PMID: 30217664; PMCID: PMC6786881.
6. Sue Reid for the Daily Mail. [cited 2023 Dec 22]. Available from: https://www.dailymail.co.uk/news/article-11086125/The-conjoined-twins-separated-UK-reveal-share-close-bond.html
7. Salih MA, Satti SA, Swar MO. Managing the common and rare in paediatrics. Sudan J Paediatr. 2012;12(2):4–6. PMID: 27493339; PMCID: PMC494989.
8. Kheir AE, Dunaway DJ, Jeelani ON, Osman NM, Omer IM, Imam AM, et al. Successful separation of craniopagus conjoined twins. Sudan J Paediatr. 2012;12(2):73–6. PMID: 27493350; PMCID: PMC4949905.
9. BBC News Health. Separating conjoined twins Rital and Ritag: the journey. [cited 2023 Dec 22]. Available from: https://www.bbc.com/news/health-14969823
10. BBC News Health. Conjoined twins: sisters meet surgeons who separated them. [cited 2023 Dec 22]. Available from: https://www.bbc.com/news/av/health-49006636
11. ARAB NEWS. Saudi surgical team separate Tanzanian conjoined twins. [cited 2023 Dec 22]. Available from: https://www.arabnews.com/node/2385396/saudi-arabia