‘Very happy’: Twins separate, but yearn for one another
NO FIRM timeline is set for Nima and Dawa Pelden's return home to Bhutan, though the twins are recovering well from their complex separation, according to their surgeons.
RCH head of paediatric surgery Dr Joe Crameri said the girls were recovering well, but there was no firm timeframe set out for their return to the Himalayas.
He said discussions were continuing among the 16-month-old twins' Australian and Bhutanese medical teams about what condition Nima and Dawa would have to be in to return to Bhutan, based largely on what services will be available in their remote home.
"We would love to have them home before Christmas, which would be about six weeks, but the reality is they go back when they are right too go back - and if that is three months, six months, then it is that time frame, but I am hoping it is not that long," Dr Crameri said.
"In reality, the girls have got to be well, we have to have all their attached tubing out before we send them back to (the Children First Foundation retreat) Kilmore, and we are still a little way off that at the moment.
"Home (Bhutan) is a broader question. Life being separated is a new experience for them.
"I think we would all like to see them become a little more independent in how they move and get better strength with their muscles and ultimately be confident in sitting up and even moving around on their feet a little.
"But I think they are very long term goals and we will set goals with Dr Karma (Sherub) and the Bhutan team to see what they can do at home, and what we need to do to get them on that process."
Providing an update on Nima and Dawa's medical recovery six days after their six-hour separation surgery, Dr Crameris said their health was tracking very well.
He said all the areas of the twins' bodies impacted by the surgery are healing well, including the wounds on the front of their abdomens that had to be covered with their own skin as well as synthetic material which should be strong enough to allow the girls confident movement within 10 days.
"The good news is that there is no news," Dr Crameri said.
"The girls have followed, largely, the path that we set our for them. Like any surgical pathway there has been a few bumps in the road and there are few bumps we are still smoothing out but, with all the resources we have here at the Children's Hospital...we are making good progress at the current time.
"The girls are getting back to a more normal life. They are back to eating and they are starting to move around.
"The area we have repaired on their tummy walls seems to be holding up to the strain quite nicely.
"We are very happy and especially mum is very happy and continuing to smile."
As well as the physical rehabilitation, Nima and Dawa also need to come to terms with the enormous emotional and mental adjustment to being separated, including being able to move away from each other and be transported in prams without becoming stressed.
"These girls spent all their lives facing one another all the time, it is hard to predict how they will cope with that. We are already getting some insight to that at the moment in that they still essentially want to be together, though they enjoy that little bit of independence, especially Nima.
"I would hope - though I am not a psychologist - that they will start to explore the world and be more comfortable moving away from one another and doing the usual things (such as) getting in prams and moving around looking at things. But I think that is going to take time."
Yesterday, the twins' mother, Bhumchu Zangmo, spoke for the first time of her elation at seeing them separated, as well their determination to remain by each other's side.
And it was revealed the sisters cannot bear to be more than about 40cm apart for more than a few minutes at a time.
But they are recovering faster than expected, enjoying cuddles with their mother, and eating solid food, including bananas and rice, as their rebuilt bodies heal.
As they laid in the same bed at the Royal Children's Hospital yesterday, the two continued to reach for the other's face, pat the other's head with hands and feet, and play all the same games they did while joined together.
While Nima and Dawa can finally experience the freedom their mother was so desperate for them to have, Bhumchu said she was overjoyed at how devoted to each other they remained.
"I am extremely happy and excited with the outcome of the surgery that my twins went through," Bhumchu said, with the help of a translator.
"I find it hard to get the right words to express my feelings of happiness and gratitude.
"Both the girls and I went through a lot of challenges, both physically and mentally, until their separation.
"I always used to get worried and anxious, especially when one of them got sick, whereby I had to carry both of them around - which was too much for them and for myself, as well.
"Now I am content that the girls can live independently like any other child out there.
"Further, they will be able to go through the normal process of growth of a child, such as crawling, walking and playing … unlike before their separation."
For 14 months, Bhumchu prayed constantly for the world to help save her daughters - even if it cost one her life - though she became extremely anxious for the six hours they were in the surgery at the Royal Children's Hospital.
Bhumchu told the Herald Sun when she finally saw them safe immediately after the gruelling operation, words could not describe the joy she felt trying to rush from one bed to the other and back.
"When I first saw them after the successful surgery, I was overwhelmed seeing them as individuals in different beds," she said. "I could not even figure out which one was Nima or Dawa. The doctors and nurses had to help me."
"My family members back home are equally happy and thankful with the outcome."
Having been the more dominant, active and desperate to be free in the twins' months together, Nima has become much more content and less frustrated in the past few days, despite being ill with a fever and having sore swollen eyes after surgery.
While the freedom appears to have had an impact on Nima's character, Ms Zangmo said Dawa remained the same calm and contented baby.
Nurse Rebecca Lyons, one of the RCH team who has cared for the pair over the past five days, said the sisters were determined to support and be with each other.
"Even at night, if we separate them they will try to do a bum shuffle to get back together," Ms Lyons said.
"Dawa is more active. She almost crawled off the bed the other day. She is definitely eating more and moving more."
While the girls still have large wounds extending the full length of the abdomen which are healing, they can increasingly be held by their mother on a couch about a metre away from their bed - at least until they notice each other missing.
At the moment five minutes - about the time needed to breastfeed each - is the limit of how long they will stay apart, but the away time is growing.
"They are usually together ... when they are apart they are looking for each other so we are tending to keep them on the same bed," Ms Lyons said.
"They have been getting up for cuddles, they have both been held by mum.
"They are all right as long as there is a second person in the room to entertain whoever is not being held.
"They can easily be 40cm apart in bed and they are fine if they are playing with toys
"But, when they go to sleep, they'll shuffle. They can't crawl yet so it's a sort of bum shuffle closer to each other. Or, they will just cry until you put them back close together."
The sisters still have a very long recovery ahead, though Bhumchu is dreaming that rehabilitation at the Royal Children's Hospital and Children First Foundation can help them take some giant steps before they fly back to their high-altitude home in the coming months.
"Before we leave for Bhutan, I am hoping they will get on their feet and start walking and I am quite excited about it," Bhumchu said.
"I am extremely grateful to all those people and agencies of Australia who were involved in making this possible.
"I used to get worried of what people might think or say about my girls whenever I took them out of the house.
"Now I am relieved of this burden and I can take my girls out in the world confidently and proudly without having to worry about anything or anybody.