Zimbabwe looks with pride at medical first

Doctors battle steep odds at rundown state hospital to separate conjoined twin boys born with shared liver.

Last updated: 04 Aug 2014 11:13
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Mugabe and his wife Grace look at one of the twins at Harare Hospital [Gift Phiri/Al Jazeera]

Harare, Zimbabwe - The separation of conjoined twin boys born with a shared liver after an eight-hour operation, and after overcoming a string of obstacles including a collapsed healthcare system, has become an unusual piece of good news here in the capital.

Joined from the breastbone to the pelvis, the twins, born at a district hospital in Murehwa four months ago, seem to be thriving and have a good shot at a normal life, said Dr Bothwell Mbuwayesango, a paediatric surgeon who led a team of 50 healthcare personnel in the operation. 

The twins probably would have died as toddlers had the surgery, conducted on July 1, not been done, the surgeon explained. 

The successful separation of Kupakwashe and Tapiwanashe Chitiyo is being hailed as a "medical breakthrough" for the impoverished southern African country, but critics say it has been used as "propaganda fodder" by the ruling regime. 

The story has saturated news coverage here and spurred "ambitious" talk that Zimbabwe's ailing health sector could become an "oasis of medical tourism where it will make sense for those in the region to start here [rather] than in Canada", according to David Parirenyatwa, health and child care minister.

Presidential visit

No such surgery had been performed before in this country, and politicians are using this case as a unique opportunity to prove that Zimbabwe is turning a corner.

It has also stirred heated debate in parliament about top politicians, including President Robert Mugabe, who regularly seek medical attention abroad while neglecting the local medical facilities.

On July 16, Reggie Moyo, an opposition MP, asked the minister of health and child care in parliament "whether the historical success of the separation of the twins ... in our health institution serves as assurance that our health delivery system is now well, and we shall not see senior members of government and the public going to seek medical attention outside Zimbabwe?"

You have done us real proud, the world will be talking about us. Some will not believe because they just do not want to believe it but the rest of the world will believe because Zimbabweans, wherever they are outside the world, are known to be best performers.

- Robert Mugabe, Zimbabwe's president

Mugabe regularly travels to Singapore for what his spin-doctors claim is "routine check-ups" for cataracts, and in May was photographed entering the top-notch Gleneagles Hospital with his wife, Grace. 

The Zimbabwean president, Africa's oldest leader, visited the boys at the state-run Harare Hospital on July 10, and said his government - re-elected to an eighth term last July amid claims of vote fraud by the opposition - will prioritise funding the health sector. 

"You have done us real proud, the world will be talking about us," the 90-year-old president said. 

"Some will not believe because they just do not want to believe it, but the rest of the world will believe because Zimbabweans, wherever they are outside the world, are known to be best performers. 

"It doesn't matter where they are, our people distinguish themselves but this distinction now right here, in the heart of Zimbabwe, in this God-given hospital, is something unbelievable. That's why I call it a mystery."

He said it was nothing short of a miracle that the surgery was conducted successfully while his government was under Western sanctions. 

The country's nursing schools produce over 500 graduates every year, but recruitment of new nurses - as with other public-sector jobs - has been frozen since 2009 as the government battles a high wage bill that is gobbling up 73 percent of the national budget, according to Finance Minister Patrick Chinamasa.

The 500 nurses graduating from government institutions every year cannot do their practical training because of the freeze. As a result, it takes them much longer to get into active employment, a situation that is not of their own making, they say.

Mugabe said health should be the treasury's top priority.

"Defence yes, but people's lives must trump everything else," he added. 

Harare Hospital, where the surgery was performed, is experiencing acute shortages of drugs, with doctors unable to dispense any medicine and largely reduced to writing prescriptions for patients to buy drugs at private pharmacies.

Most of the state hospitals are poorly equipped with old and obsolete equipment that urgently need replacement. Doctors at most state hospitals generally lack the tools of the trade, health personnel say.

Shortage of drugs

Paul Chimedza, the deputy minister of health and child care, told parliament on July 16 that his ministry was aware that there was a medicine shortage and admitted that "the government does not have the resources". 

"We get most of our medicines from NatPharm and at the moment NatPharm does not have the capacity to buy medicines in bulk," Chimedza said, referring to the procurement agency for medicines and other medical supplies for the Ministry of Health and Child Welfare. 

Dewa Mavhinga, senior researcher for Southern Africa at Human Rights Watch, said it was a "gross exaggeration" to call the separation of the conjoined twins a "medical breakthrough".

"Real medical breakthroughs include South Africa being the first country globally to have a successful heart transplant with many more being carried out without much noise about it."

But Itai Rusike, ‎executive director of the Community Working Group on Health (CWGH) - a network of civic organisations that aims to collectively enhance community participation in health in Zimbabwe, said the surgery could signal a turning point for the health sector.

"The praise by … Mugabe to the Zimbabwe medical team that successfully separated the conjoined twins is very welcome and encouraging as it may result in a sustained political will that is urgently needed in reviving the fortunes of the public health system that has been on a decline for over a decade now," Rusike said.

Rusike was, however, quick to warn that government should live up to all its international obligations.

Health experts say only 25 percent or fewer of conjoined twins survive, and often one twin must be sacrificed to save the other, depending on which organs they share. Kupakwashe and Tapiwanashe were born facing each other, connected from the from the pelvis to the breastbone. 

Real medical breakthroughs include South Africa being the first country globally to have a successful heart transplant with many more being carried out without much noise about it.

- Dewa Mavhinga, senior researcher for Southern Africa at Human Rights Watch

A homegrown effort

Their father, Moses Chitiyo, 45, is a vendor on a farm in the village in Murehwa, in northern Zimbabwe.

Their mother, Agnes Mongoro, 25, is a housewife and had planned to give birth at home as is customary in much of rural Zimbabwe, but was taken to the nearest district hospital when complications developed. When the conjoined twins were born, doctors sent the family by bus to Harare.

Paediatricians got help from local donors and drug companies and Dr Mbuwayesango believed an operation to divide them would succeed.

He helped arrange for the hospital to do the operation - for free - and for several charities to help support the Chitiyo family.

The operation finally took place on July 1, with 40 staffers in the operating room and the rest providing support services. 

"There is no one surgeon, nurse or anaesthetist who can separate Siamese twins," Mbuwayesango told reporters.

"We had a team of 50, plus or minus, comprising of nurses, doctors, cleaners, cooks etc. We needed everybody to be able to separate them properly. We did not get any help from outside of the country."

Almost three weeks later, they squirm and squeal in their parents' arms. 

"They are feeding and breathing on their own," Mbuwayesango said. "They are active, happy and they look strong."

Mbuwayesango foresees no major problems.

"They will be normal, happy boys."


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