Uganda’s first and oldest successfully separated siamese returned to Uganda. Agnes Kyotalengerire met them.
Christine Ajone and Loice Senema were Uganda’s first Siamese twins to be separated successfully. Ten years ago, they were born in Arua district and separated successfully in the University of Maryland before being returned to Uganda.
The twins before separation
Due to their parents’ poverty, the twins were eventually taken to a babies’ home in Jinja, from where they were adopted by an American medical researcher, Dr. Cindy Howard, who had arranged for a surgical operation to separate them in the US.
The twins now live with their adopted parent in St. Paul, Minnesota, USA.
Yesterday, Cindy flew back to the US after a three-week visit to Uganda.
They were hosted by Mulago hospital paediatrician, Dr. Sabrina Kitaka and her husband at their home in Mutundwe, Kampala.
Dark complexioned, slender and tall, the two little girls are adorable, warm and wear a smile, revealing their beautiful black gums. In a soft spoken American accent, they had an opportunity to play with other Ugandan children they met.
The twins’ biological mother, Margaret Atai, a Kakwa by tribe, belongs to a cross-border community in West Nile, where national boundaries mean nothing. Whereas she lived with her husband in Leiko, Koboko district, her father-in-law had migrated to Buranga village in the Democratic Republic of Congo (DRC), 26 km from the border.
On October 28, 2001 Atai had visited her father-in-law when labour pains began. For one and a half days, she tried to push, with the help of a traditional birth attendant, but the baby would not come out. Her in-laws decided to take her to hospital.
Vehicles were hard to come by. “It took them close to three hours to transport her on a bicycle to Adi Hospital, where the babies were delivered by Cesarean section,” said Gideon Yaka Onziga, a cousin to Atai’s husband.
The twins were attached from the breast bone to the navel and shared a main blood vessel that supplied their hearts. The doctors referred them to Arua Hospital.
The twins with their mother and Ozinga
All along, the twins’ father, Deneya Dhuki, was sick. His cousin, Onziga, took care of Atai at Arua Hospital, Mulago Hospital and even travelled with her to USA for the operation.
Onziga said they almost failed to travel to Mulago Hospital because they lacked money. “The bus fair to Kampala cost about sh18,000. I was forced to sell my bicycle for sh80,000 to raise transport and money for up keep in hospital,” he recounts.
Dr. Margaret Nakaketo, the Special Care Unit Mulago Hospital at the time, said the twins were immediately admitted in Special Care Unit.
“A team of surgeons and pediatricians made investigations and discovered that they could be saved if operated on,” Dr. Nakaketo said. However, surgery could not be done in Mulago Hospital because the hospital lacked the required facilities.
She requested Dr. Cindy Howard, who was the head of health volunteers overseas and was in the hospital for a one-month exchange programme to take the twins to the University of Maryland in the US for surgery.
“Dr. Howard was the only person we could look up to for help. Luckily, when she contacted the University, the surgeons accepted to carry out surgery free-of-charge,” she narrated.
The twins were small. They had to be fed to gain reasonable weight before they could be operated on. After four months of close monitoring, Atai and the twins together with Onziga were flown to the US.
The twins were given a warm welcome to Uganda
Surgery in the US
After another one month, a team of 35 doctors carried out the surgery at the University of Maryland Medical Centre in Baltimore, Maryland, USA. The team included a paediatric surgeon, heart surgeon and three plastic surgeons.
“After the surgeons cut and clipped the main blood vessel, the two separate hearts started to function immediately. We knew it was a success,” Howard recalls.
Thereafter, the children were kept in the Intensive Care Unit for six weeks under the care of 22 nurses, before being released.
“Atai continued to breastfeed as well as feeding them on other foods. They grew very fast and by the time we celebrated their first birthday, they were already walking,” recalls Onziga.
A month later, Howard returned and got the children into the Orphanage. Atai had requested Howard to take the children to America because they were very delicate and she could not manage to care for them. Howard filled an application for guardianship and Justice Vincent Rwamisazi Kagaba granted Howard adoption on April 25, 2003. It is from that time that Ajone and Senema had Howard added as their third name and became American citizens.
The 10-year-old twins are attending P5 at Laura Jeffrey academy in the US. “I love school. I have lots of friends; they are all nice and funny. The teachers are good and always make jokes in class,” Senema, one of the twins, said.
Senema wants to become a doctor while Ajone wants to become a teacher.
Howard said adopting the twins at the age of 50 and being a single parent working full time was not easy. “I prayed that God would provide me the support to raise the twins. But after a few weeks, I realised that the twins had gotten attached to me,” she recalls. Fortunately, she has been blessed with good friends and neighbours who love and care for the girls.
At the ages of one and later five years, Senema underwent surgery to correct heart problems. She also had a hip surgery because it was not growing well. She will probably undergo two or three more hip surgeries.
Besides, the children had asthma but have been on medication for the last nine years and they are doing well,” Howard affirmed.
Despite such challenges, they are jolly children. They look alike so much that you can only differentiate them by the hairstyle. Often, they do the same thing at the same time. When you see one folding her arms, chances are the other is doing the same.
Yesterday, they travelled back to the US without meeting their biological parents, who now live in Buranga village on the DRC side of the border as peasant farmers.
Howard explained that adopted children normally go through a process of psychological preparations before meeting their biological parents. This process, she said, has already started.
She has been telling the twins about their biological mother. “Gradually they are beginning to get interested and when they feel they are ready, I will take them to see their parents,” Howard said.
First return to Uganda
Soon after the first birthday, Onziga and the twins returned to Uganda accompanied by Howard. They received a hero’s welcome in Leiko village in Koboko. “People back home were very happy to see the twins healthy and grown.”
However, Onziga recalls the children’s health deteriorating in the first two weeks. He suspects change in weather could have affected their health.
The children started falling sick and because they could not afford to care for them, Onziga rang Howard to take the twins for treatment.
Arrangements were made and Dr. Christine Ondoa, now health minister, picked the twins and together with their mother, brought them to Kampala. Later, they were taken to Welcome Orphanage in Jinja while a solution was being found.
“Our worry was losing the babies after they had been successfully separated,” said Nakaketo.
5 voices you must hear
My twin sister is funny, nice, kind and whenever I get hurt she cares for me. But sometimes she can be really annoying because she does not like it when mum says no. I think it is special to be born twins but not normal to be born stuck to eachother. Mum told me that we were born stuck together on the chest. Then we got separated in the University of Maryland.
I like my twin sister because she plays with me and when I am not feeling well, she gets things done for me. We spend most of the time together playing and watching funny movies which make us laugh. We also love reading a lot.
According to Dr. Charles Kiggundu, a consultant gynecologist working with Mulago Hospital, conjoined twins are like other identical twins except that the process of separation is not completed after fertilisation.
“Separation of the fertilised egg has a time limit of about 65 days. If the egg has not separated completely by that time, the babies end up joined at certain parts and sharing some vital organs such as liver, heart or the brain.”
He estimates that about 50% of conjoined twins will make it to full term while the rest end up in miscarriages. He notes that the condition is more frequently found among females. Female Siamese twins tend to have a higher chance of survival.
Globally, the prevalence of conjoined twins is estimated at one pair for every 200,000 live births.
Biological mother, Margaret Atai, 30:
It was my second pregnancy. I did not expect to deliver twins and I was shocked to see them joined at the chest. I feared so much and did not expect them to survive for even a day.
Carrying and breastfeeding them was a problem because they were stuck together. When I was told they would be taken to US I was very happy because I wanted my babies to be separated. Luckily, they were separated successfully. They recovered well and I continued breastfeeding them while they ate solid food. They put on weight and after they made a year, we returned to Uganda.
We have never seen them since Dr. Howard took them away. I do not know whether I would recognise them if I met them. But I imagine they are now grown up.
Biological father, Deneya Dhuki, 35:
We would like to see the girls but they are far away. We believe one day Dr. Howard will bring them to visit us. We believe that they are getting good education and that they will take care of us in future.