Children's Hospital Los Angeles Leads Historic Medical Moment 3,000 Miles Away

A 18-person medical team left Children’s Hospital Los Angeles two weeks ago to head to Haiti on a medical mission. The task at hand was a medical procedure six months in the making with world-renowned surgeons poised to separate twin girls—Marian and Michelle—who were conjoined at the abdomen.

Surgical Leadership

CHLA’s surgeon-in-chief and Chair of the Department of Surgery, Henri Ford, MD, MHA, has been making regular visits to Haiti to support the complete revamp of the country’s medical infrastructure following the 2010 earthquake. He was the first physician in our 18-person clinical team to meet the infants and begin planning for their eventual separation. James Stein, MD, MSc, FACS, FAAP, CHLA’s chief medical quality officer and CHLA surgeon participated in the historic event. Stein has separated multiple sets of conjoined twins and knew exactly what would need to be done to orchestrate this complex procedure for the nearly six-month-old girls.

The Clinical Team

Once Dr. Ford agreed to take on the surgery, he set about developing a team of experts—CHLA surgeons, physicians, anesthesiologists, intensivists, physician residents, fellows, nurses, and respiratory therapists—to support the care of the girls. In all, it would take a team of 18 people to support the complex care that would be needed for Marian and Michelle. They would partner with 12 clinicians from University Hospital and Hospital Bernard Mevs Project Medishare in Haiti to prepare for, conduct and provide for the recovery of the twin girls.

Timeline of Events

September 2014

• Mother, Manoucheca Ketan, age 35, undergoes an ultrasound in Haiti. Doctors find that she is carrying triplets, two of which are conjoined.

November 2014

• The three girls are born at 36 weeks at University Hospital in Haiti.

December 2014—April 2015

• Dr. Ford visits Haiti repeatedly to perform pediatric surgeries. At each visit, he examines the twins and begins logistical preparations for the surgery and assembles the team.

May 1-4

• Dr. Ford and several team members make a final visit to Haiti to prepare for the surgery.

May 20

• CHLA’s team of 18 clinical experts depart from Los Angeles to Haiti where they are joined by 12 Haitian physicians and nurses at University Hospital.

May 21

• The entire international team gathers in the surgical suite and performs a three-hour dress rehearsal at University Hospital, where the twins have been cared for in the hospital’s neonatal intensive care unit since birth.

May 22—Day of Surgery

• 8 a.m.—The surgical team of 28 from four hospitals (Children’s Hospital Los Angeles, Keck Medicine of USC, University Hospital and Hospital Bernard Mevs Project Medishare) gather at the hospital to begin preparations for the surgery.
• 10 a.m.—Marian and Michelle, now three days shy of six months, are wheeled into
• surgery. Anesthesia is administered.
• 1:14 p.m.—The first incision is made by surgeons along twins’ shared abdominal wall.
• 2:23 p.m.—The sisters are surgically separated.
• 2:50 p.m.—The sisters are moved to separate tables in the surgical suite and the medical team divides into two teams to perform closing surgical procedures on the girls.
• 4:45 p.m.—Marian’s surgery is completed and she is wheeled to the hospital’s neonatal intensive care unit, staffed by CHLA neonatal intensive care nurses and intensivists and University Hospital medical staff.
• 4:58 pm – Michelle’s surgery is completed and she joins her sister in intensive care, where the girls now have separate hospital beds.
• Time elapsed for surgery – 6 hours and 58 minutes.

Within 48 hours, both girls were breathing on their own without the assistance of oxygen and were feeding on breast milk and formula 72 hours later—milestones of success. Now just over six months of age, both girls are progressing through their recovery well.

In the coming weeks, the girls will recover from their medical procedure and undergo physical therapy to help strengthen neck muscles weakened due to facing in a single direction for such a long time. “The girls look great; we don’t expect any more surgeries,” Stein says. “This was all about planning and organization. The amazing part for all of us is conducting seven hours of surgery, and then seeing two kids side-by-side, when there used to be just one. It’s just awe-inspiring.”

Added Ford: "I liken the entire international team of surgeons, anesthesiologists and nurses to a symphony orchestra.”

National Pride for Haiti

The day of Marian and Michelle’s surgery was not just an important day for them—it was a day of national pride for their entire country. This complex surgical procedure and its successful outcomes signaled to Haitians that they not only can recover from a devastating earthquake, but surpass their former medical capacity in five short years following the 2010 disaster.

Give Kids a Helping Hand

It takes skilled hands to tend to the very special needs of children with complex medical issues such as those experienced by Marian and Michelle in Haiti. Every day, children with complex medical issues are helped by the hands of the caregivers at Children’s Hospital Los Angeles. With a gift of any amount, you can help us treat kids better right here in Los Angeles, and around the world. Support the Helping Hands Fund at www.CHLA.org/HelpingHands.

Congratulations to Drs. Ford and Stein as well as to the entire clinical team, for their medical leadership in such a historic moment.