Guatemalan girls go head to head

August 5, 2002 7:29 PM

Guatemalan girls go head to head before 50 doctors try to pull them apart.
posted by swift (34 comments total)

Umm....oh no....not cnn......?

50 people is quite a bit. I hope the old 'too many cooks spoil the soup' adage proves to be false here.
posted by mogwai at 7:38 PM on August 5, 2002

God bless them and all the doctors. But still...my feeling is that doctors, like the rest of us, love a challenge and that there are a lot of very sick babies (and adults) who, being just ordinarily afflicted, will never get this kind of attention.

That's ungrateful, I know. And there's probably nothing to back up this hunch of mine. For the record, my identical twin daughters were born very premature (six months, 900 grammes, 29 centimetres) and, thanks to Crumpsall Hospital in Manchester, U.K., are now tall, healthy, beautiful 21-year-olds. But they were a challenge too.
When they were born there were three doctors, two nurses (and about twenty-odd students) in the O.R. "Ordinary" mothers had to get by with a midwife, in humiliating surroundings.

If there hadn't been such a risk with my daughters, they wouldn't have got that sort of attention. But who knows?
posted by MiguelCardoso at 7:39 PM on August 5, 2002

Miguel, you are bitter. These doctors are specialists not only helping these kids, but expanding medical knowledge on future conjoined twin problems. Rare does not necessarilly mean undeserving. Its a bit self-centered to go on about how those in need get help but Joe Sixpack can't get a break on his mortgage. I would think there's a lot more research and true and tried techniques in helping the common problem of premature birth as opposed to the rare problem of seperating the conjoined.

Click here to see a gallery of the conjoined twins

Err, no thanks.
posted by skallas at 7:54 PM on August 5, 2002

You're right, Skallas. Thanks. It was more a fear - perhaps guilt? - than a supposition.
posted by MiguelCardoso at 8:00 PM on August 5, 2002

Vis-a-vis the gallery. I checked it out because I couldn't parse the X-ray. (They are rotated one from the other.) But the pictures are actually mostly cute.
posted by Wood at 8:01 PM on August 5, 2002

God, the scariest thing in that whole article was this:

they were born after the mother underwent an eight day labour...

Sitting with my legs crossed, cringing in sympathy. It's amazing that she survived this, really.
posted by jokeefe at 8:20 PM on August 5, 2002

jokeefe said: God, the scariest thing in that whole article was

Yeah, I can't even fathom that. Eesh.

But I also thought it was pretty scary that this is all taking place at the Mattel Children's Hospital.

But I guess that's better than the Staples Children's Hospital.
posted by tittergrrl at 8:31 PM on August 5, 2002

It's hard to imagine that the mother had a normal pregnancy (although it says so in the caption to one of the pictures). Then I realized that the twins together weighed less at birth than most single-birth babies. That these twins survived is really amazing. I've got my fingers crossed for a successful separation surgery.
posted by bonheur at 8:37 PM on August 5, 2002

On NPR, I caught a headline about 'doctors attempting to separate conjoined twins from Guatemala...' Took me a minute to place the prepositional phrase with the correct antecedent.
posted by tippiedog at 8:46 PM on August 5, 2002

Offtopic, how common is midwifery in Portugal, Miguel? And what are the surroundings that are so humiliating?

Midwifery has basically been banned in the US for the better part of a century, probably because of homogenization of immigrants and semi-abolishment for the sake standardization/health of the country. iirc, midwives aren't allowed to oversee birthes in a hospital to this day.

I've never known a woman who gave birth anywhere but a hospital with the help of a doc and attendants. Though, I think most of them were counting on being able to scream "give me drugs! shoot me up, god damn you!" when it got too tough to hyperventilate. Is a hospital birth something of a luxury there?
posted by stavrogin at 8:53 PM on August 5, 2002

My first reaction: "Are you thinking what I'm thinking?"
I'm a terrible person.
posted by ColdChef at 8:56 PM on August 5, 2002

in re to stavorgin/"offtopic"- speaking from the US, I think it depends more upon $/insurance/hmo. Roughly 1/3 the women I know who've given birth in the last 5 years have used midwives. All except one at home. The other woman used a midwife at a hospital after whatever legal/malpractice issues were taken care of (even in this case, I *think* the HMO arranged or recommended the midwife). My point, some hospitals have standard practices for utilizing midwives if asked (persistently, perhaps).
posted by G_Ask at 9:12 PM on August 5, 2002

Stavrogin: My daughters were born in England. Due to a "hysterical pregnancy" on my part (a strange itching condition caused by empathy with the mother of one's baby) my therapy was to stand by and comfort unaccompanied women who wanted a non-medical guy to talk to. So I witnessed about a dozen deliveries. All were headed by midwives, i.e. my probably medieval designation for non-doctors (trained obstetric nurses) specialized in assisting childbirth. Although they were all successful, I was quite shocked by the small delivery rooms and too-efficient and matter-of-fact assistance.

And, yes, it's true that they all scream for drugs - it's extremely painful. In England, though, they were very mean with the drugs.

In Portugal - a Latin country - childbirth is a big emotional thing and there's always a doctor present. Drugs are freely dispensed. Deliveries under general anaesthetic are common. Middle class women have their children in private hospitals. I'm middle class so my experience here is probably not typical. Generally a woman's gynecologist and an obstetrician are with her from the moment she gets to the hospital.

It's a cultural thang, like so much else. English practice struck me as too cold and clinical. Before my daughters were put into incubators they were left 24 hours lying in a cot, the "rationale" being that, if they survived a day, they were worth saving. This seemed so Spartan to me at the time I almost tore the hospital apart.

But, as I said, they were right and I was wrong. Mollycoddling is not a good thing. I have to thank British efficiency for my daughters' survival and good health.
posted by MiguelCardoso at 9:19 PM on August 5, 2002

Everyone's born in a hospital in Portugal, in case that wasn't clear. Our health service is free, universal and quite good.
posted by MiguelCardoso at 9:33 PM on August 5, 2002

Our health service is free, universal and quite good.

Jesus. Now even Portugal is making the U.S. look stupid.
posted by Optamystic at 9:45 PM on August 5, 2002

G_Ask, I guess I'm unfamiliar with modern treatment of midwives or, really, their responsibilities. I'm not too certain where midwives come into play with a pregnancy nowadays. I understand they're licensed in some way, but I'm fuzzy on how involved they are in childbirth. But, then, I'm fuzzy on the whole modern childbirth thing.

Miguel, I'm amazed at premmies being tested in "cots" before bothering to put them in an controlled environment. Thank god they survived, may they take over the world and impose their will through the iron fist of oppression.

It's interesting, though, that the gynecologist and osbtetrician are present throughout the pregnancy. I don't think that happens in US births. 'course, I'm probably wrong. But, from what I gather, the people who deliver the babies are the people who are around at the time.
posted by stavrogin at 10:03 PM on August 5, 2002

Waddya mean, even Portugal? Be careful I don't haul your ass over to MeTa because of that racist remark, Optamystic!

On a serious note: in Western Europe (and, do not forget, wondrous Canada), if money is no object, the best private treatment you can get is, say, 25% better than your average non-paying João, Juan, Jean or Joe. In the U.S. that difference is more like - what? - 500%?

On the other hand, no matter how rich you are, you can never get the very best possible medical treatment. You can only get this in the U.S. That's why rich Europeans go there when they're really ill.

This stinks somehow, no?

Still, as you imply, health-wise and politically speaking, the U.S. is very, very Third World. Tee hee. Serves you right, you arrogant, self-absorbed, though strangely loveable bastards. ;)
posted by MiguelCardoso at 10:07 PM on August 5, 2002

'Strangely Lovable Bastards'. This should be the official slogan of the USA.
posted by stavrogin at 10:18 PM on August 5, 2002

I thought it was "More than just bombs and fat people!"
posted by muckster at 10:39 PM on August 5, 2002

Mattel's charitable foundation donated $25M to rebuild the hospital, which was damaged in the Northridge quake. "It will feature a lobby designed by renowned architect I.M. Pei that will contain oversize replicas of such Mattel toys as Barbie, Hot Wheels and the Fisher-Price Little People." Well ... I'm sure the kids will enjoy it.

Part of the reason for the large team is that it's really three teams: one to oversee the separation surgery, and then two parallel teams to perform the extensive repair and closure surgery; and since the surgery takes so long, there are also often two shifts. There will be some overlap, of course, but you're basically talking about probably no more than a dozen people in any single operating room at once. You'll need the normal array of assistants in anesthesia and surgeon's nurses, as well as organ specialists for each one that's shared, orthopedic surgeons for any muscular and bone reconstruction, and plastic surgeons to deal with the skin (on a very preliminary basis: survival is most important now).
posted by dhartung at 10:46 PM on August 5, 2002

I don't want to derail the thread, but midwifery is very much alive and well in the United States, and yes, they are licensed. And, contrary to Stavrogin talking out of his ass, some of them (Certified Nurse Midwives) do deliveries in hospitals. I probably only know this because my mother practiced as an American midwife who worked at a nationally-accredited midwifery school and was also the president of MANA (Midwifery Alliance of North America). Regardless: check the links for some info about how midwives are trained and organized in American these days.

Sorry again for the derailment: I just wanted to make a couple corrections...it's my duty as a good daughter. Now back to your regularly scheduled discussion of conjoined twins.
posted by arielmeadow at 11:27 PM on August 5, 2002

Seeing as the thread is semi-derailed anyway, we also have a pretty good free medical system (pretty good=better than nothing) here in Australia. Babies are almost always born in hospital. There is not necessarily a doctor present at the birth, although one may be overseeing several births at once, with the real work being done by obstetric nurses (and the mothers, of course). Drugs are freely given (not to the father unfortunately), but premature babies are not given any survival tests to see if they are worth saving. Recent years have also seen a move to earlier releases from hospital, with mothers sometimes leaving as early as several hours after giving birth and nurses then visit the baby at home for several days to monitor its progress.
posted by dg at 12:12 AM on August 6, 2002

dhartung, I saw a while ago a show on how one of these separations was organised and the logistics of organising all the separate teams and shifts was frightening enough, without the fact that there are two lives hinging on the whole thing working out. The amount of equipment needed to ensure that, whatever happened, anything needed was to hand was staggering and the number of medical specialists on stand-by in case of complications was huge.

I wonder if the reason that the US seems to be the only place where this type of surgery can be done is because of their lack of free medical facilities, meaning that facilities are developed with the knowledge that prices can be charged that will allow hospitals to recoup their costs, where other countries are dependant on the public purse to fund medical advances and this limits them to keeping up with the basics.

An 8 day labour? Holy shit, that must have hurt. I cannot believe that a c-section was not performed, but perhaps rural Guatemala doesn't have the facilities.
posted by dg at 12:25 AM on August 6, 2002

arielmeadow, I just went through a midwife-assisted birth in April. I now recommend it highly to anyone who will listen. People like your mom do good work! Tell her so. Then again, I'm sure she knows.
posted by whatnot at 6:38 AM on August 6, 2002

Back on track: the two Guatemalan twins - remember them? - have been successfully separated.
posted by yhbc at 7:13 AM on August 6, 2002

DG. I think you are entirely correct. Look at the medical procedures and technology (both hardware, like surgical tools or prothesis, and software, like pharmaceuticals) that come out of the US medical system. There is not question that a profit motive helps radically advance medical technology and procedure, which is then, after a lag, often adopted and used throughout the rest of the world. So you could say, in a way, that the US "regressive" medical system actually is a public good that benefits the rest of the developed, and developing, world. And there is no question our medical schools are the best anywhere, by a long shot.

On the other hand, there are still gross inequities in the US medical system, which I feel are unconstiutional. Goverment has to ensure all citizens life liberty and pursuit of happiness. With, what is it, 40 million uninsured Americans, many of them children (and this ignores those with expansive and spotty insurance) it can not be said that the basic needs of all Americans are met. But, what is the answer? How do we preserve the unique creative spirit of American medicine while extending its benefits to everyone?
posted by pjgulliver at 7:30 AM on August 6, 2002

YEAH FOR THE TWINS!!!!
posted by pjgulliver at 7:30 AM on August 6, 2002

But, what is the answer? How do we preserve the unique creative spirit of American medicine while extending its benefits to everyone?

I believe that is referred to as having one's cake and eating it too. It's not generally regarded as a tenable proposition.
posted by IshmaelGraves at 8:53 AM on August 6, 2002

Modern Medical Ethics
What do you do when, together, conjoined twins are doomed, but separated one has a chance at life. This was the case two years ago when the parents of Jodie and Mary were ordered by the British court to allow the hospital to perform the surgical separation. Mary died (or rather, was sacrificed) and the separation was called murder and mutilation.

Interesting fact: 70% of all conjoined twins are female.
posted by Secret Life of Gravy at 9:55 AM on August 6, 2002

Another update: one girl had complications with the surgery.

70% of all conjoined twins are female.

How bizarre.
posted by emyd at 1:27 PM on August 6, 2002

But, what is the answer? How do we preserve the unique creative spirit of American medicine while extending its benefits to everyone?

I believe that is referred to as having one's cake and eating it too. It's not generally regarded as a tenable proposition.

Unfortunately, it seems that less well-off Americans will continue to suffer from second-rate medical treatment so that the rest of the world can benefit from America's fully commercial medical model. Hardly seems fair, does it? I know that many people in Australia complain about delays for surgery etc, but they do not realise how lucky they are. At least here you can be sure that, if you really need it, quality medical attention is available free and you will never be denied essential treatment due to your financial status.
posted by dg at 5:08 PM on August 6, 2002

Lets not applaud the system to death just yes, even if we ignore the 40+ million uninsured we still have both the uninsured and insured going broke over medical bills.

Half of US bankruptcies in 1999 due to medical bills.

Americans are paying for the amazing progress in medicine, which has given them the illusion that almost anything is possible, said Prof. Warren."It was very unlikely 30 years ago that an ordinary family could run up a half-million dollar medical bill, yet today that can happen in a matter of weeks in a major medical centre," she said. "We can do extraordinary things -- we can save tiny little babies born with defective hearts or older people who can live many more productive years -- but the price is more than middle-class families can afford."

posted by skallas at 8:31 PM on August 6, 2002

As an aside to all of the other discussions in this thread, I couldn't help but notice that the xray on CNN's website is actually an MRI scan, which is something quite different. It is this inability to get even basic facts right when it comes to science/technology/medicine that makes me wonder about the ability of mass media to report on these subjects.
posted by TedW at 8:32 PM on August 6, 2002

That's pretty scary, skallas - I am not sure how the bankruptcy laws work in the US, but it is fairly easy here to declare bankruptcy and be back in the clear a few years later - much easier than paying back half a million in medical bills!

We seem to have come almost full circle back to MiguelCardoso's comment about this case getting attention because it is unusual and challenging, while those who have more ordinary problems go unnoticed.
posted by dg at 11:59 PM on August 6, 2002