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June 2, 2006
Journey of a thousand miles
Doctor's African sojourn helped save conjoined twins in Canada.
DAVE GORDON
Conjoined twins are a medical marvel and a dangerous combination,
even in state-of-the-art Canadian hospitals, but despite being in
the backwoods of Zimbabwe, Dr. Rachel Spitzer helped twins who were
fused together to beat the odds.
Last March, Spitzer combined her medical expertise with advocacy
for the at-risk children to help the twins not only survive, but
thrive.
Relatively early in her career, the 29-year-old Torontonian has
experienced what most would consider a career highlight, garnering
international attention. Besides seeing the daily miracle of life,
Spitzer, along with other Toronto doctors and organizations, helped
give a normal life to a set of conjoined babies.
The story began in June 2004, when Elizabeth Mufuka came into Howard
Salvation Army Hospital in Zimbabwe. She was pregnant and saw Dr.
Paul Thistle, an obstetrician in charge of the hospital. Thistle
performed an ultrasound, discovering that not only was she carrying
twin boys, but they were conjoined, attached at the torso. Spitzer,
a Toronto obstetrician who was serving in rural Zimbabwe for three
months as a volunteer, assisted him. They saw this medical anomaly
firsthand, a few weeks later, when the twins were delivered by caesarean
section.
Conjoined twins make up one in every 200,000 births and more are
likely to occur in Africa or India. Three-quarters are stillborn
or die within a day. One out of every 200 sets of identical twins
is conjoined, but most of them don't survive. Or if they do, they
are joined in such a way that they cannot be surgically separated.
The birth of conjoined twins was something Spitzer never thought
she'd see in her career. "I'm at the start of my career and
it's a very strange feeling to know that you're having a highlight
of your career so early on. It was quite extraordinary," she
said. But the real highlight was yet to come.
After Tinashe and Tinotenda were born, Thistle and Spitzer set out
to find a way to separate the twins. They knew the surgery could
not be done in most places in Africa, so Spitzer researched hospitals
around the world. She reached Dr. Jack Langer, the chief of general
surgery at the Hospital for Sick Children in Toronto.
"Ultimately, it was the only hospital that offered both medical
expertise and the financial option, through the Herbie Fund,"
Spitzer said, referring to the humanitarian fund established in
1979 specifically to help children who cannot get the necessary
medical treatment in their home country.
Within weeks, the application to the fund was approved. "Raising
the $100,000 was something we thought was not possible," said
Spitzer. But that still did not factor in nursing, midwives and
other expenses. The Salvation Army covered the cost of flights and
other expenses, in partnership with the host organization, Ve'ahavta,
which supported the Howard Hospital for many years. The Canadian
Automobile Association also provided adult health insurance. The
surgeons donated their expertise and time.
Tinashe and Tinotenda arrived at Sick Kids in December 2004, accompanied
by their mother and their nurse. "It was a few of those surreal
moments, when they were getting off the airplane," Spitzer
said, recalling her internal dialogue when the twins arrived: "My
God, we actually managed to do it!"
Over the course of a few weeks, a team of specialists led by Langer
evaluated the twins' medical condition. The boys subsequently suffered
infections, contracted the flu and were in isolation for two weeks.
After their recovery, Tinashe and Tinotenda were ready for their
surgery – where it was uncertain if both babies would survive.
If one of the twins died, deadly toxins would seep into the other
twin. More than 25 people were involved in the operation and Spitzer
was given the opportunity to observe in the operating room that
day for the successful five-hour surgery. The babies left in full
health.
What began as what Spitzer described as "a perfect opportunity
to spend time abroad" turned into a heartwarming story of generosity,
reaching across geographic and cultural boundaries.
No stranger to isolated areas of the world, Spitzer's interest in
international health has taken her to places like Uganda, Nepal
and twice to Zimbabwe. In a typical day in rural Zimbabwe, Spitzer
treated many women during and in recovery from labor, performed
ultrasound scans and did research. She was one of just 900 doctors
working in Zimbabwe. She once performed four c-sections in one weekend,
and often found herself with midwifery students who had little experience.
She lived in a "little house nearby, in the compound, with
no phone, no Internet, no TV."
The hospital, off a dirt road, contains 130 beds. Spitzer said that
it's the referral hospital for a population of a quarter-million
people.
"Without question, though, the hardest part was all the patients
that we lost, especially the babies." Supplies were often critically
low at times, and she'd be faced with the last box of gloves, the
last bag of blood or the last bottle of certain medications.
"It's sometimes a matter of what is donated from abroad,"
Spitzer noted. "All in all, though, you make do with what you
have. You can do very simple blood tests; you cannot do cultures
for infections to diagnose, you can't measure liver or kidney functions."
As for medical staff, sometimes there were as few as one, or as
many as three, according to Spitzer.
"You have to work on your own judgment," she said. "Doctors
are not always available to inform [you] of timely decisions. It
involves creative management solutions, a lot of feeling of futility,
you feel limited in some ways. Some days are very frustrating and,
in some ways, you know you could do better."
Spitzer is now back in Toronto, where she and her husband, Mark,
have bought a home. In the next year, she hopes to complete fellowship
training in pediatric and adolescent gynecology and a master's in
public health. She hopes to practise obstetrics and gynecology with
a focus on international health. If the determination and motivation
she showed in Zimbabwe is any indication, Spitzer will surely be
successful. Africa, she said, was "the most fulfilling experience
of my life."
Dave Gordon is a freelance writer living in Brooklyn,
N.Y. He has written for the Baltimore Sun, Toronto Sun and
Pittsburgh Post-Gazette, among others.
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