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tv   Our World  BBC News  September 21, 2019 4:30am-5:01am BST

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reached its climax in new york, with a rally addressed by greta thunberg. the swedish teenage addressed large crowds in the city praising everyone for taking part in what she called the biggest climate strike in history. this is safa's brain, it looks happy... demonstrations have taken this time the surgeons will separate place in across egypt the shared network of veins that against the government. drain blood from twin‘s brain. they called for president abdel fattah al sisi to go and demanded an end to military rule. but disturbing this equilibrium egypt has seen very few protests in the six years since president abdel fattah al sisi could also do permanent damage. a portion of each twin‘s brain is being supplied by the other twin. took power in a coup. so there is a real risk of causing a stroke at the time of the surgery, a woman who claims she was abused that is something that is by britain's prince andrew weighing heavily on us. as a teenager, has given her first there could be something down television interview there that i can't see about the allegations. virginia roberts giuffre described at the moment. the prince as "an abuser". buckingham palace emphatically denies the duke of york had any the more the surgeons try to divide sexual contact with her. the vessels that link and nourish them, the more unstable the twins become. the parents of a student who took her own life while at university, we're going to have have called on colleges to help stop to take ventilation down.
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0k? others from "falling through the cracks". down? ceara thacker was found dead in her room in may 2018, three months after an earlier suicide attempt, which her parents marwa's heart begins to fail. were never told about. from the inquest in liverpool, we are not stable, here's our education editor, branwen jeffreys. but we are less unstable. good enough for me. at liverpool university, new students are starting. the anaesthetists manage two years ago, ceara to stabilise the girls thacker was among them. so the operation can continue. the 19—year—old struggled with because marwa is clearly the weaker anxiety, depression and self—harm. twin, the surgeons decide she asked for help many times. to give her a key shared vein. today, her parents the operation lasts 20 hours. called for change. she approached every service available to her. every one of those services let her down. at every turn, she was failed. i can't imagine how frightening that so i'm relieved, i'm relieved. i mean there was a chance we were going to... potentially lose marwa must have been for her. during the surgery. it's been a big operation, but hopefully if they wake up as we hope they will, it's gone well. yeah. this is absolutely essential, that all universities have proper systems for identifying students but shortly after surgery, at risk, and communicating effectively with health care services and, where appropriate,
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with families, to ensure safa suffers a stroke. they are kept safe. on the 21st of february 2018, ceara takes an overdose. her gp wasn't told by the hospital, the warden at the halls didn't tell the university. there was a period on tuesday evening where...we felt on the 22nd of february, that we were very close to losing ceara contacts the university counselling service. safa, and that she stayed in that critical state for... she wasn't seen for two months. on the 23rd of march, ceara asks for help from the nhs, for 48—72 hours after the surgery. the talk liverpool service — she's passed on as a non—urgent case. it was a very difficult time on the 24th of april, for the girls, their families and the entire team ceara tells the university counselling service she's thinking of suicide. looking after them. on the 11th of may, ceara is found dead in her room. the coroner said it wasn't certain in a break from their work at great ormond street, the two lead surgeons are in ireland what difference all of this made. to meet another set of twins. when students arrive, their parents now get information about support. there are more counsellors
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it's eight hears since they last on campus, too. we really do pass on our heartfelt saw ritaj and rital. sympathy to the family. one lesson — to work it's hard to believe that these closer with the nhs. sisters, born in sudan, to share information much more were once joined at the head. effectively and in real time. thank you! you are very welcome. the hope — to prevent another student falling through the gaps. branwen jeffreys, back then the surgeons feared the girls might die unless separated. and this was rital and ritaj just bbc news, liverpool. one month after surgery. each parent able to hold now on bbc news, our world. a child in their arms. safa and marwa are identical twins joined at the head. their family, from pakistan, i hope that they will get want doctors to separate them. great ormond street in london is one a normal life and be treated as normal human beings. of the few hospitals in the world with the expertise to do it. their father is now a doctor in ireland. we are now sitting here with two healthy twins, just like what i hoped at that time. this is safa's brain, that's marwa's brain. what we need to achieve is effectively untwist the brains, and that is difficult, so it's a great moment pretty difficult to do just in your head. in my life as well. so the dream came true? exactly, yeah. i'm a very proud dad now. that was a very hard time. and at the same time it was a happy
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but it is perilous. the bbc was given unique access to chart the complex medical time because of the conclusion. and ethical choices made... rital has some learning difficulties. by the long—term outcome of the twins' separation has been hailed as a major success. the surgeons believe it's this is the day, the moment because it was done in the first of truth, and everything hasjust year of life. got to be perfect. the hope of giving the girls independent lives. safa and marwa are 21 months old, and were born in pakistan. they have come to london's great what we put the two kids ormond street hospital through and the brains with their mother zainab, through is a lot. grandfather and uncle, and are under the care and the younger brains and the younger circulations are better adapted. of neurosurgeon owasejeelani. everything is easier. a one—year—old's regenerative it is clearly very difficult to go capacities are so much better. the skin heals better, through life when you are joined it stretches better, together like that, so it does make the bone grows in better. a very persuasive case in favour of doing the surgery. the family are very clear on that. they're setting up a charity so that funds are available to pay for early intervention in future cases and for research into the best way
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clearly, life being separate is very to separate conjoined twins. much better than life together. it's january 2019. if we felt there was not a very, very high chance that we could do it safely, we would be thinking about whether we should do it or not. i think the last two months after their last operation on the brain has been a little bit of a stormy time for safa and marwa. they've had ups and downs with infections and temperatures and marwa's heart is having work quite hard for both of them i think the whole team feel and that's causing her a few challenges. that there is an excellent chance but they're hanging in there. of a successful separation here. and they're both reasonably well. the twins' father died just before they were born, and then it took more than a year of fundraising before a donor stepped in to cover the medical costs. safa and marwa are what's known as craniopagus twins, which meansjoined at the head. the next challenge for the surgeons their skull is one long tube. the twins share many is to ensure each twin will have key blood vessels. enough skin to cover their skull separating these will be a major challenge. when they're eventually separated. both twins' brains have a distorted appearance. they do this by encouraging one half is pointing up the skin to expand. the tissue expanders are balloons into the other girl's skull cavity. that sit underneath the skin every last detail of the twins' and they have a tiny little extraordinary anatomy has been recreated digitally. port attached to them through which we can inject saline. so the idea now is that we will gradually inject the tissue expanders and they will blow up like a balloon and the skin over
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the top of them will stretch. and it's a very, very effective technique of making more skin out of the skin we have available so that when we come to separate safa and marwa there's enough skin to cover both of their heads. plastic surgeon david dunaway these are rare cases leave a lasting will be in charge of rebuilding impact on the surgeons. the girls' skulls after neurosurgeon owasejeelani has separated the twins' brains. they showed me how 3d modelling has if i may, i haven't asked david's permission to say this. but the last separation that we did, when the kids were finally helped them to prepare. separated, and everyone was overjoyed and so on and so forth, and people were happy, this hemisphere, which is the right and i looked at david and he had tears in his eyes. hemisphere of the brain, is standing up, so this is actually projecting into the other child's skull. what we need to achieve is to effectively untwist the brains, and that's difficult, and he denies it to this day, pretty difficult to do just but he did at that time. in your head. for surgeons it is massively yeah. ithink... helpful, actually being able everybody has been so invested to touch and hold things makes in this for so long. it is a surprisingly so much difference to understanding emotional thing, i think, how things are. when they finally come apart. we spent a long time and when that experience of them looking at these models actually leaving the operating and going through the what—ifs. theatre as two separate people
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numerous models of the twins' brains and shared skull had been created using this 3d printer. the whole process takes two days. this one will help surgeons plan how is quite indescribable. best to divide the layer of skin on the girls' skull once they are separated. and they're not only using physical models. this is surgery without scalpels. at last, four months since the first surgery, the day of separation. absolutely incredible. two forceps. all laid out. this is exactly what we wanted. virtual reality has helped the team plan how to divide the twins' shared arteries and veins. so this is safa's brain that's marwa's brain. if you do give me a seven. little by little, the bone and the tissue which joins them is cut. so they are separate apart from that piece ofjewellery. and then, after seven hours, the final connection is severed. it works, it really works. fantastic. 0k. and so now we can see a whole done.
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lot more information, a level of detail we've not been able to access previously. this is clearly the way of the future. we're using this technology for a highly complex case, but many other routine operations that we do, brain tumours, blood malformations, so on and so forth, the rest of those malformations, this would be hugely, hugely beneficial for those cases as well. ok, have we got everyone here? yeah? so we have one case for the list today, safa and marwa, it's in a very emotional moment. we've been working a long two kids, one case. time to get them here. they've been through so many operations and now it's worked. you still have four, five hours to do? yeah, we have to put them together now. the surgery is so complex it so we've taken them apart and now will happen in three stages over several months. we have to reconstruct their heads. and the twins won't be physically marwa is still in the operating separate until the final operation. theatre through here, the aim of the first while safa has been operation is to separate moved just next door. the twins' shared arteries. for the first time, the survival of each of the twins is not dependent on the other. and that'll make it easier for the two surgical teams to regulate their heart rate, blood pressure,
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and other vital signs. safa and marwa's brains used to have a distorted shape. but four months ago a plastic sheet at present, each child is supplying was inserted between them and by gradually tightening the pressure it has largely corrected their appearance, essential before their skulls can be rebuilt. this means both teams can the other‘s brain with blood. begin reconstruction. the patchwork of skull pieces one, two, and three. what we're doing now is, the two arteries that are shared between theatres. are going from one twin to the other, so we can see the artery but to do anything to it we'll use the microscope. so the artery from safa going to supply marwa's brain has been clamped. so a piece for me, a piece for you. but every time this is done, to have enough to cover their heads, each fragment must be divided in two. the skull is very usefully designed in three layers. there's a risk of brain damage. so there is an inner layer of very thick, tough bone, an outer layer of thick, tough bone, and in between it the bone is like a honeycomb, ok, so the brain's looking good. so you can split the bone, it's half the thickness, but it means we should be able
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to cover nearly all of the head with bone afterwards. this shows the jigsaw of bone the twins have been in theatre now fragments that were pieced together for more than seven hours. and there are still several hours of this operation to go. so far, everything is going to plan, to form the skull of marwa on the left and safa on the right. and both girls are doing well. the gaps have been seeded with bone cells. while one team works on the twins, and in the months to come these another, led by david dunaway, constructs a frame made from pieces should slowly close up. of the girls' skull which can be detached in subsequent operations. the final task of the 17—hour operation is to stretch the skin over their reconstructed skulls. it's a pretty amazing day, isn't it? this central segment will be our rigid keel to hold the head together. what we need to do is make sure that the twins are rigidly together. being older, they're pretty active, and so whatever we do really has to be strong enough to resist the twisting and bending forces that they'll be putting on their heads. everything is good. thank you. the first operation lasts 15 hours. oh, what a day.
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they have been quite amazing zainab has seven more children back throughout, actually. they're great family and i think they draw strength from one another. and they seem to be getting through it very well. in pakistan, aged 5—16. we asked mum who she would pick up all of them were born at home, first, whether it was safa or marwa? but with this pregnancy she was advised to and the answer was both — with support! so, ah, yeah... deliver in hospital. the road to recovery for the twins is slow, but four months after separation, safa and marwa are beginning to make progress. it was not until five days after delivery by cesarean section that zainab was introduced to her # hello, safa. daughters, initially by photo. zainab says the twins have distinct personalities. 00:11:36,784 --> 2147483051:42:33,107 after a month, the twins 2147483051:42:33,107 --> 4294966103:13:29,430 are back in theatre. # hello, marwa. # how are you today? the twins have daily physiotherapy. it's hoped this will help them reach some basic milestones — learning to roll, sit, and hold their heads up. # twinkle, twinkle, little star. # how i wonder what you are...
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safa has not fully recovered from her stroke. we made the decision that the bulk of the common vessels go to marwa, the weaker twin. and because of the decision safa suffered a stroke. so what i really want to see is the weakness safa has at the moment, and she has a weakness in her left arm and left leg, improves. so for me the big moment's going to be when she walks and when she uses her left arm properly. because, you know, i have given her that weakness and for me that's a hard thing. nearly a year since they were admitted to hospital, the girls are leaving great ormond street. the family will stay in london until the twins are strong enough to return to pakistan. the donor who paid for the surgery is continuing to support them.
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they are clearly going to face some challenges. but i think, overall, it's a positive outcome for them. they are going to need support, but they have a chance of leading a happy life. whatever hurdles safa and marwa may face in years to come, they will at least do that as a separate, independent girls. twins still, but conjoined no more.
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hello. friday brought a lot of sunshine to a lot of places across the british isles and i don't think we're going to see a radical change for many areas on saturday. simply because the overall pattern is still pretty similar. high pressure in the continent, low pressure in the atlantic, therefore, we are still tapping into this run of south—easterly airs and quite strong winds at times, up from the mediterranean, through the near continent and into the heart of the british isles. that is dry air so we are not seeing an awful of cloud for most of us just at the moment. the exceptions to that, the northern ireland ‘s and later in the day, the first signs of the atlantic front trying to cloud things over in the south—west. an onshore breeze from the north sea will keep the eastern coast down at about 15, 16, 17 but come inland, 20 plus is widely available. through saturday night and on into sunday, the first signs of the change in that the high—pressure drifts further away and in comes the front from the atlantic. that will set the tone for sunday. before the persistent rain arrives,
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we will have some quite sharp showers and maybe the odd under storm gradually drifting up the spine of the british isles and then the front makes progress away from the western fringes ever further towards the north and east and to avoid that rain, some of it quite heavy will have to be that further north and east. still, the temperature in excess of 22—23 degrees or so towards the east but fresh air is coming in from the atlantic and that sets the tone for the start of next week. monday, not too bad. the rain from sunday gradually eventually clearing away from that far north—eastern corner of scotland and then a lull in proceedings and then late in the day, more signs of the next belt of wet and windy weather pushing in from the atlantic into the south—western quarter of the british isles. not cold by any means but the temperature is back on what we have seen at the weekend. and then as we move from monday into tuesday, that area of low pressure becomes pretty resident out towards the western side of the british isles and at times, through the next few days, it will be throwing these belts
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of cloud and wind and rain across many parts of the british isles. it's all going to be quite mobile so it won't rain persistently anywhere for the whole day but while that rain is around, you will notice it, this is not showers, thisis belts of rain moving in from the atlantic. and there is not a great deal of difference as we go from tuesday into wednesday. low pressure still out towards the west of the british isles, still with these weather fronts working their way in and at times, some really quite strong winds. quite a change on the way.
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welcome to bbc news, i'm reged ahmad. our top stories: protesters around the world have taken to the streets in a global call for action against climate change. we are united behind the science and we will do everything in our power to stop this crisis from getting worse. in egypt, rare protests against president sisi, with many calling for him to stand down. the us is sending military troops and equipment to the gulf, in response to last week's attack on saudi oilfacilities. and, the woman who claims she was abused by prince andrew speaks out. buckingham palace emphatically denies he had any sexual
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