His Excellency the Minister of Health, Dr. Abdullah Al Rabeeah, is also the head of a medical team conducting surgeries to separate conjoined twins. At a lecture delivered last Sunday at Imam Muhammad Ibn Saud Islamic University, Dr. Al Rabeeah declared that the successful separation of numerous sets of conjoined twins in the Kingdom is a symbol of what is best about Islam, our nation and our people. Next to Allah’s help, good teamwork is the major factor in the many successes achieved in the area of conjoined twin separation. The Kingdom has ideal medical facilities and medical expertise available to ensure that the children have the best possible chance of a positive outcome from their treatment here.
Attending the lecture was Prof. Dr. Suliman Aba Al-Khail, University Rector, along with college deans and university students. During the presentation, entitled “Team's Experience and Country's Success,” HE Dr. Al Rabeeah discussed the unique medical and social challenges faced by the team and by the parents of the twins. He also discussed the lessons he’s learned during his career as Head of the Medical and Surgical Team while carrying out these complicated and difficult operations, and how his experiences may help medical students today.
HE began his lecture with a historical view of the 1st reported conjoined twins, who was an Armenian twin in 1945. The most famous conjoined twins were Chang and Eng Bunker (1811–1874), Thai brothers born in Siam, now known as Thailand. They traveled to America and worked in a circus for many years, and were billed as the “Siamese Twins.” Their attachment was relatively simple. If they had lived in the twenty-first century instead of in the 19th, they would have been good candidates for surgical separation. They lived to the age married unattached sisters, had 22 children between them, and died in 1874 at the age of 63 within minutes of each other.
Dr. Al Rabeeah added that the history of conjoined twins in the Muslim world is not documented in the West, but that the oldest case on record according to his research was in the reign of Umar bin al-Khatab in 638 AD. In that case, twins were born with four upper limbs, two lower limbs and two external genital organs. They died within a few weeks of birth.
The first known attempt to separate conjoined twins took place in Germany in 1495. One craniopagus twin died, and an unsuccessful attempt was made to separate the dead twin from the living one using an axe. The living twin passed away after an hour.
In 1689, the first known successful twin separation was performed using a constricting band. The same method is used nowadays to treat anal fistula.
Cases of conjoined twins are very rare, at only one per 200,000 births. That rate is higher (1 per 25,000 births) in Southeast Asia and Africa; this is due to an increased rate of the incidence of identical twins; the identical twin birthrate is the determining factor in the birthrate of Siamese twins.
60% of conjoined twins are stillborn, 40% of the live births die within a few days, and 70% are females. Most conjoined twins are joined at the chest, thigh or pelvis; others are joined at the head, while the rarest cases involve abdominal heteropagus.
The causes for the condition are unknown. Research studies confirm that conjoined twins occur when a fertilized ovum (egg) begins to split into identical twins, but is somehow interrupted during the process and develops into two partially formed individuals who never fully separate from each other in uterus.
The practice of separating conjoined twins in Saudi Arabia began 21 years ago in 1990. Of the 64 cases considered, 29 ended in separation; 34 were inoperative because of life-threatening deformities in the infants. The medical and surgical teams involved in these operations included medical staff from 17 different Arab, Islamic and Western countries.
In addition, Dr. Al Rabeeah discussed, in his lecture, each of the 29 cases including their circumstances, the separated organs, challenges and screening and diagnosis methods used.
Dr. Al Rabeeah stated that the separation of conjoined twins has taught us a lot about teamwork, exchanging experience, trust, leadership and setting a good example for students. Teamwork is the basis of success, he said, and team members must be willing to discuss all aspects of the case objectively and to listen to the opinions of others.
Dr. Al Rabeeah emphasized that his team has benefited greatly from Islam, which is a tolerant religion that encourages cooperation. The Cameroonian conjoined twin case eventually led to the conversion to Islam of an entire Cameroonian village as a direct result of the benevolence of the Custodian of the Two Holy Mosques (May Allah Protect Him.)
Following his lecture, HE received a first class scarf from Imam Muhammad Ibn Saud Islamic University, and received a special gift for the occasion. Dr. Al Rabeeah finished his visit with a tour of the university’s College of Medicine.