Jaga and Kalia, the conjoined twins. Image source: The News Insight

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Puspanjali Kanhar and Bhuyan Kanhar were a poor tribal family living in Milipada village in Odisha’s Kandhamal district. They had two sons Dhaitya and Ajit. The couple later had twins which to everyone's shock came as conjoined twins!

Conjoined twins are identical twins whose skin and internal organs are fused together with each other. Babies develop from a single egg, which in the case of twins splits into two. However, in case of conjoined twins, they are unable to split properly. Half of the conjoined twins are stillborn and the survival rate is between 5% to 25%. 

The twins born to Puspanjali and Bhuyan were not only conjoined but suffered from a very rare condition of craniopagus- a condition where the heads are joined together, which only happens once in 2.5 million births.

This rare case was highlighted in the local media which caught the attention of the State government. The government promised to bear all expenses and at the age of 2 years, the twins were brought to AIIMS, New Delhi. 70% of the brain was infused in one twin, and the rest 30% was infused in the other.

The doctors examined the twins and explained how the twins shared a common blood supply channel to the brain. The operation for separating the twins went on in stages. Initially, an alternate pathway was developed to build up nutrition and blood vessel then the operation for separation began. 

Doctors from different disciplines of AIIMS got together for surgery. Classifying this surgery as complex would be an understatement. It's been recorded that since 1973 only 60 such surgeries have taken place. The last one was reported in Philadelphia that year in June. The data showed there was less than a 20% chance of survival among the craniopagus twins undergoing surgery. However, the doctors said that the twins have beaten worse odds by making it to this age sharing the same brain tissues. 

The team of 40 doctors, 20 nurses, and other paramedical staff in 36 hours announced the successful surgery of separating the twins. However, as the doctors know better, it was early to celebrate since the next coming hours after surgery are most crucial.

The twins after the successful surgery. Image source: PIB

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> The main challenge of the doctors was to provide skin cover to the holes left in the head of the separated twins. "The skin was generated from the expansion of two balloons which were placed inside their heads during the first surgery in August," said the doctors. The twins were kept on a ventilator till they got out of the anaesthesia. After the skin coverage, working on the reconstruction of their skull was the next big challenge.
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The doctors exclaimed that initially, Jaga was healthier, but now his condition has deteriorated. Kalia is better. Over in all the surgery was a success and the twin's condition somewhat stabilised. However, the twins also suffered from other health issues. While Jaga had heart issues, Kalia suffered from kidney problems. 

Kalia's condition over the years didn't go up and unfortunately, he lost his life on 26 November 2020. His condition deteriorated in the last 5 days and he was put on a ventilator. Even with the best efforts of doctors at SCB Medical College Hospital, Cuttack, they lost him to an extreme case of septicaemia, a condition of blood poisoning. 

His father Bhuyan said that Kalia wasn't destined to live with us for long. His brother, Jaga is doing better. The entire community mourns for the loss of Kalia and wishes good health for Jaga.

On 27 October 2017, the doctors of AIIMS became successful in separating the conjoined twins, Kalia and Jaga, in a surgery that was the first of its kind for India. It would be an understatement to classify the surgery as complex. However, one of the twins lost his life last year leaving his twin forever. 