DANIEL: National Highway 69, the main artery through the geographic heart of India. I’m on my way to witness what I’m told will be one of the most incredible things I’ve ever see – but first I need to arrive in one piece.
My destination, a small mission hospital that dreams big, where the community will soon be caught up in something extraordinary.
Stuti and Aradhana, 11 month old twins are the stars of this tale. That’s Stuti in the orange and Aradhana in the green.
And the support cast – three doctors from Australia who’ve accepted an enormous challenge – to help give these twins new life at this simple country hospital. What happens here will captivate a nation of more than a billion people and put the spotlight on the way India treats baby girls.
Life in India’s central state of Madhya Pradesh is typically poor. Most live off the land, and hand to mouth. They have a hospital at the tiny settlement of Padhar, but it’s 200 km, about a 4 hour drive from the nearest major city. And it was here that a 22 year old farmer’s wife arrived giving birth to twins and in trouble. It was days later when she emerged from the fog of her own recovery, that she was shocked to find they were conjoined.
DR DEEPA CHOUDHRIE: “Within a week of their birth, the parents had decided that they didn’t want the children because of their deformity and the fact that they were poor. And there may have also been an element of the fact that they were female children – we’re not too sure about that”.
DANIEL: Dr Deepa Choudhrie and others stepped in to care for the twins who were signed over to the hospital. There’s plenty of love to go around here. Stuti and Aradhana have become part of a great big family.
DR DEEPA CHOUDHRIE: “Well they are absolutely adorable. If you see Stuti she’s shy, she’ll smile but she’s shy and Aradhana will see you from a distance and her face will light up and she’ll be pedalling away and waving her hands and cooing and yeah they’re really adorable”.
DANIEL: It’s only in the last few weeks that Stuti and Aradhana’s mother has been back at the hospital and by their side. The return of the twins’ mother has unsettled staff, who’ve been treating the children as their own. But mother Maya tells me while she left the children at the hospital where they’d get the best care, she’s changed her mind because they may soon be able to live a normal life.
MAYA YADAV: “I was very sad and when I used to think of them, I would get fever. I missed them a lot. But I couldn’t do anything, they could not stay with me, so I had to leave them here.
DANIEL: The ambitious plan to separate the twins was hatched by two Indian doctors who studied together, paediatric surgeon Dr Gordon Thomas who now works in Sydney, and Dr Rajiv Choudhrie, now the head of Padhar Hospital.
DR GORDON THOMAS: “He called me and told me that these girls were born and if I could come and help separate them. So I said you’re kidding? You’re going to do it here?”
DR RAJIV CHOURDHRIE: “We kind of just stuck to our guns and said we will do it over here because they belong to us and if there is something that is needed of us we have to be able to step up to the challenge”.
DANIEL: It’s certainly that. So they recruited the best in Australia, two eminent doctors from the Children’s Hospital at Westmead in Sydney.
Leading the team is renowned paediatric surgeon Dr Albert Shun, who has saved the lives of hundreds of children through 250 liver and 100 kidney transplants.
DR ALBERT SHUN: “The operative procedure should go as according to plan and I don’t anticipate too much difficulty, but having said that there’s always maybe some surprise and we’ve got to deal with that as it comes”.
DANIEL: Dr Shun and anaesthetist Professor David Baines are veterans of this kind of complex surgery. They’ve each been involved in the separation of three sets of conjoined twins and they’ve paid their own way and donated their time to attempt it again.
PROFESSOR DAVID BAINES: “I get an enormous amount of gratification doing it. I get far more out of it than what I put into it but I think the most important thing about it is working with people who are like minded, who are professionals and who just get a job done”.
DANIEL: Stuti and Aradhana have separate hearts but they’re in the same sac so that will have to be split and made into two. Even more complex, they share a single liver. Scans show that one of the girls might be missing two of the three crucial veins that drain blood from the liver.
The tiny community of Padhar has never had so much attention.
LOCAL JOURNALIST: “Maya, come here, we just want to talk to you for two minutes”.
DANIEL: The fate of the girls has been national news for months, the parent’s decision to abandon them analysed and judged by the India media.
DR RAJIV CHOUDHRIE: “She doesn’t want to say anything”.
DANIEL: When the hospital made a video about the twins to attract funding, they were catapulted into the national spotlight. Viewers donated the equivalent of thousands of dollars to pay for their separation.
Their case has sparked national debate about the treatment of baby girls. About 12 million Indian girls have gone missing in the last three decades because they’ve been either aborted or killed after birth.
DR DEEPA CHOUDHRIE: “In some parts of India, including this part, families find girls to be a burden because they have to put a lot into their education and into their growth and everything and finally all that happens is that you have to give the girl away in marriage and for that also you have to give what’s called dowry. So they’re not really looked upon as something that they want”.
DANIEL: But Stuti and Aradhana’s mother tells me she didn’t abandon them because they were girls.
MAYA YADAV: “No, we do not differentiate between girls and boys. They are the same. In fact girls are preferred because in their heart they have that motherhood feeling and boys don’t. Children are children – we do not differentiate”.
DANIEL: This tiny community is suddenly on the map and the sense of expectation is huge. Treated as VIPs, the doctors are publicly honoured in a ceremony of local officials to bless the operation.
The medical team does a practice run. There are dozens of people in the theatre and even more opinions. But it’s good natured and productive.
“Do you get nervous before an operation like this?”
DR ALBERT SHUN: “Yes, yes every time we do a big operation. The nerves is a good thing I think because it makes you appreciate what you’re doing, makes you more on edge, aware, helping to prevent and look out for things and makes you more alert”.
DANIEL: It’s the big day and the last chance to see Stuti and Aradhana as conjoined twins. The media isn’t going to miss this shot. Their mother Maya is locked out, left to the mercy of the cameras.
Inside, anaesthetist David Baines is leading the team preparing the babies.
PROFESSOR DAVID BAINES: “I figure the best chance they’ve got to make a life of - some sort of life - is to be separate so I think all you can do is offer them a chance and the future will be what the future will be”.
DANIEL: The anaesthetists are soon joined by the rest of the team. Two dozen Indian and Australian doctors will be working side by side to separate these two baby girls. The risks are great, but doctors are used to that.
DR ALBERT SHUN: “You’ve got to basically do harm to do good and you’ve got to sort of learn to dissociate with that and the bottom line you always look at and appreciate that what you achieve at the end is worth the suffering you’re going to cause”.
DANIEL: In the room next to the theatre, staff gather to watch the surgery on a live TV feed. All of them have been somehow involved in the care of the girls and there’s obvious tension, more so here than inside the theatre.
DOCTOR : “What’s very significant is you can see the two hearts in the same sac. It’s a very romantic sight because it’s two hearts touching each other”.
DANIEL: “It’s so hard to describe but two little hearts beating together like that for the last time I suppose”.
DOCTOR : “Yeah”.
DANIEL: “Soon they’ll be separate hearts I guess”.
DOCTOR: “Yes separate hearts”.
DANIEL: “Amazing…”.
DOCTOR: “That’s right. I told you before…”.
DANIEL: “You told me it would be the most amazing thing I’ve ever seen – probably true”.
The team separates Stuti’s heart from Aradhana’s but there are a few tricky moments as the doctors have difficulty manipulating the two little hearts into place. It’s not just the surgery that’s throwing up challenges. Even with the best efforts of the hospital to step up, this is still remote India and some things are difficult to control.
DOCTOR : “Fly!”
NURSE: “Shall I catch it?
DOCTOR: “No, no you won’t be able to catch it”.
NURSE: “I catch it. I can catch it”.
DOCTOR: “You won’t be able to catch it”.
NURSE: I can catch it.
DOCTOR: “I’m betting…”.
NURSE: “I can catch it”.
DOCTOR: ‘Did you get it?”
NURSE: “No”.
DANIEL: “Well it’s time for a breather for me, we’re about five hours in but there won’t be much of a break for those inside until the surgery is complete. So far the hearts have been separated and the doctors are now working on halving their liver”.
It’s a painstaking process which takes hours.
The operation is almost over. Stuti and Aradhana are apart for the first time.
“Are you happy now?”
DR ALBERT SHUN: “Oh very happy, very good. Very good. Thank you.
I’ll have a cup of tea”.
(CHEERING CROWD OUTSIDE)
DANIEL: It seems everyone in Padhar has turned out to celebrate. There’s sheer jubilation when word comes that the operation is complete and when Stuti is wheeled out of theatre first, the joy erupts. Media swamp medical staff who have to carefully move the sleeping baby into ICU dodging camera crews. It’s chaos. I come across parents Maya and Hariram, shell shocked at the edge of the crowd. They haven’t seen their children since before the surgery began. [Zoe showing photos of the surgery to twins’ parents on her iPhone]
Aradhana is also at the centre of the scrum when she’s brought out of surgery a few minutes later, delayed by a complication. Anaesthetist David Baines is right in the thick of it for the second time as he shepherds the sleeping baby safely through the bedlam.
PROFESSOR DAVID BAINES: “That was something that I’d never experienced before and I am unlikely to experience again. Just as we went in the door there was a spontaneous sort of cheering and applause went on which was unexpected I must say and sort of exciting in a way to think you know yeah we have actually achieved something”.
DANIEL: [to baby’s mother] “Do you want to go to see the babies? I hope they let us in. Dave… Just mum and dad only I think”.
PROFESSOR DAVID BAINES: “Just ten minutes”.
DANIEL: It’s a confronting moment for their mother. Stuti and Aradhana are both in intensive care, not only are both babies in a critical condition, they’re in separate beds for the first time”.
MAYA YADAV: “I’m not feeling very good to see them in the Intensive Care room like this. Once they’re fully healed, I’ll be much happier”.
DANIEL: Father Hariram has been keeping a low profile in the lead up to the operation but he’s here tonight.
HARIRAM: “I’ve been waiting eleven months for this operation. Stuti and Aradhana were playing before and I was hoping after the operation they’ll be normal and happy again. I’ve been praying for this day”.
DANIEL: The doctors are still at work. The twins make it through the critical first night. They’ll need weeks of post-op care and many follow up operations but the work of the Australian doctors is almost done and they have to return to Sydney. The babies are still highly vulnerable to infection. It’s difficult to leave.
PROFESSOR DAVID BAINES: “We hope that things will go well for them, but at least now, touch wood, as long as everything goes well for them that at least they’ve got a chance and that’s all we can offer them at this stage”.
DANIEL: It’s almost 2 weeks since I left Padhar to return to my base in Bangkok. The doctors have been keeping tabs on the twins from afar and they’ve been keeping me informed as well. Then one morning this email from Dr Gordon Thomas.
[reads email] “Dear Zoe, Aradhana sadly passed away early this morning. We thought she would make it. Sadly she didn’t”.
In Sydney the doctors come together again to talk me through what happened. It’s hard to know exactly why Aradhana died, a collapsed lung, infection and the sheer trauma of the separation all probably played a part. In the end her little heart just stopped.
DR GORDON THOMAS: “They had attempted to resuscitate her for almost six hours so they kept going for about six hours so she twice she actually returned and then the third time it was actually, no she just didn’t. So they tried very hard. Unfortunately she didn’t make it”.
DANIEL: So far away from Padhar, the doctors struggle to make sense of what’s happened. The risks were high but no one expected to lose a child.
DR ALBERT SHUN: “In paediatric surgery, even though I do a lot of high risk surgery, mortality is a low thing for us to cope with. We don’t have many babies that die so when there is actually someone that dies it hits us pretty hard. I feel very, very sorry for the loss of the baby. I mean and I was totally devastated that day”.
DANIEL: Overall the doctors stand by what they did, but there are inevitable questions about whether it was right to separate Stuti and Aradhana and at a remote hospital.
PROFESSOR DAVID BAINES: “I feel that you know we did the best we could and probably offered them the best chance they had so I… but that won’t stop us asking the question over and over again and it’s something we’ll think about for the rest of our lives”.
DANIEL: For me, it’s a long road back to Padhar knowing that the community has lost one of its children, but I’m anxious to see how Stuti and her big family are recovering without her twin sister. Padhar’s been national headline news all over again for all the wrong reasons.
DR RAJIV CHOUDHRIE: “The amount of planning that had gone into this was phenomenal but strangely we were not ready for this event”. [wiping tears away]
DR DEEPA CHOUDHRIE: “Amazingly that never struck me, you know that we would lose a baby. So I don’t think I even thought of death”.
DANIEL: But there’s another little girl whose recovery remains a reason for celebration. Stuti is well and truly up and about and she remains the centre of attention at the hospital even though Aradhana is desperately missed. Stuti has just turned one. It’s impossible to know if she realises she’s lost her sister.
DR DEEPA CHOUDHRIE: “Before the surgery it was very easy to carry the conjoined twins. You know you carry them both together and you can kiss them both at the same, and I used to think my goodness it’ll be so difficult when they are separated, how will I manage to carry both of them together? And that never happened. I never got to carrying them together. But yeah Stuti, Stuti’s there so I’m really grateful for that”.
DANIEL: Today Stuti is going to see her family. Her parents went back to their village soon after the operation and have seen her only a couple of times since. It’s many miles from the hospital at Padhar and bad roads make travel difficult, especially now during the monsoon. It’s a bittersweet moment for the family to welcome just one of their girls home. They had big plans for both Stuti and Aradhana to come back and live at the village after their separation.
MAYA YADAV: “I am so happy, but at the same time I am very sad. Had both my daughters lived, they’d have come home together”.
DANIEL: Aradhana is buried by the river. Just days after her first birthday, she came here from Padhar for the first time to be laid to rest on her family’s farm. Questions linger about Stuti’s future. She has two homes, one at this simple remote village, the other at the hospital where she’ll need to spend a lot more time for further surgery.
DR DEEPA CHOUDHRIE: “There will always be a place for Stuti if she comes to Padhar to come home and I mean I think the family are glad that there is at least one. Both of them could have gone when you think about it but I think the fact that we have one I think that is a blessing and I’m really grateful to God for that”.
DANIEL: It’s been a rollercoaster ride for everyone who’s been on this journey with Stuti and Aradhana. A tiny hospital in the centre of India has been propelled to prominence by a team of doctors and in a nation that often mistreats girls, two babies captured the country’s heart. Stuti remains a symbol of hope and survival for all.