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tv   Our World  BBC News  December 22, 2019 3:30am-4:01am GMT

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the australian prime minister scott morrison has cut short a family holiday in hawaii, after he'd been heavily criticised for leaving the country in the middle of a bushfire emergency. fires are burning across three states and are expected to get worse. the death toll from a storm that battered spain, portugal and france has risen to eight people, with the affected areas bracing for the arrival of more violent weather. a strengthening storm, given the name fabien, is expected to bring downpours and strong winds to parts of western europe. tokyo's olympic stadium has officially been opened. sixty thousand people were given a glimpse of how the 2020 opening ceremony might look, with traditional drummers and a parade of dancers in vivid colours. the first sporting event to be held at the national stadium will be the emperor's cup soccer final on new years day. one of itv‘s most popular shows,
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dancing on ice, is to feature a same—sex couple as contestants, when it starts its latest series this evening. the steps singer ian "h" watkins is teaming up with professional dancer matt evers. our correspondent lizo mzimba reports. dancing on ice is one of tv‘s most popular shows, often producing memorable moments of all different kinds. ian "h" watkins and matt evers have been rehearsing for weeks and when the programme returns tomorrow night, they'll be the first same—sex couple seen competing on a prime—time british show like this. it's about time. if we had something like this when we were children, maybe i wouldn't have felt so isolated. i wouldn't have run away from home. you know, in everyday life we see gay couples and we see same—sex couples. so it should be no different with what we are trying to do. it something that has already been embraced in other countries on similar shows.
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israel's dancing with the stars featured a same—sex celebrity couple back in 2009. last month's strictly here saw two male professionals dancing together. it prompted around 200 complaints. 200 people complained, but there were millions of people that stood up and applauded. ten million. ten million viewers and there was 200 complained. perhaps the strongest message so far has come from denmark's dancing with the stars. last month, a celebrity same—sex couple won — with the public deciding the vote. something that h and matt will be hoping to repeat here in the uk. lizo mzimba, bbc news. now on bbc news, one of the most striking stories of 2019 from our world. safa and marwa are twin girls who were born joined at the head, then brought from pakistan to london for highly complex operations. fergus walsh followed them
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through the dangerous nine—month process. a warning — his film contains images of surgery. safa and marwa are identical twins joined at the head. their family, from pakistan, want doctors to separate them. great ormond street in london is one of the few hospitals in the world with the expertise to do it. this is safa's brain, that's marwa's brain. what we need to achieve is effectively untwist the brains, and that is difficult, pretty difficult to do just in your head. but it is perilous. the bbc was given unique access to chart the complex medical and ethical choices made... this is the day, the moment of truth, and everything hasjust got to be perfect. the hope of giving
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the girls independent lives. safa and marwa are 21 months old, and were born in pakistan. they have come to london's great ormond street hospital with their mother zainab, grandfather and uncle, and are under the care of neurosurgeon owasejeelani. it is clearly very difficult to go through life when you are joined together like that, so it does make a very persuasive case in favour of doing the surgery. the family are very clear on that. clearly, life being separate is very much better than life together. 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 whole team feel that there is an excellent chance of a successful separation here.
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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. their skull is one long tube. the twins share many key blood vessels. separating these will be a major challenge. both twins‘ brains have a distorted appearance. one half is pointing up into the other girl's skull cavity. every last detail of the twins‘ extraordinary anatomy has been recreated digitally.
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plastic surgeon david dunaway will be in charge of rebuilding the girls‘ skulls after neurosurgeon owasejeelani has separated the twins‘ brains. they showed me how 3d modelling has helped them to prepare. this hemisphere, which is the right 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, pretty difficult to do just in your head. for surgeons it is massively helpful, actually being able to touch and hold things makes so much difference to understanding how things are. we spent a long time looking at these models and going through the what—ifs. 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 best to divide the layer of skin
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on the girls‘ skull once they are separated. and they‘re not only using physical models. this is surgery without scalpels. absolutely incredible. this is exactly what we wanted. virtual reality has helped the team plan how to divide the twins‘ shared arteries and veins. it works, it really works. and so now we can see a whole 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
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those cases as well. ok, have we got everyone here? yeah? so we have one case for the list today, safa and marwa, two kids, one case. the surgery is so complex it will happen in three stages over several months. and the twins won‘t be physically separate until the final operation. the aim of the first operation is to separate the twins‘ shared arteries. the aim of the first operation is to separate the twins‘ shared arteries. at present, each child is supplying the other‘s brain with blood. one, two, and three.
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what we‘re doing now is, the two arteries that 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. but every time this is done, there‘s a risk of brain damage. ok, so the brain‘s looking good. the twins have been in theatre now for more than seven hours. and there are still several hours of this operation to go. so far, everything is going to plan, and both girls are doing well. while one team works on the twins, another, led by david dunaway, constructs a frame made from pieces
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of the girls‘ skull which can be detached in subsequent operations. 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. the first operation lasts 15 hours. zainab has seven more children back in pakistan, aged 5—16. all of them were born at home, but with this pregnancy she was advised to deliver in hospital.
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it was not until five days after delivery by cesarean section that zainab was introduced to her daughters, initially by photo. zainab says the twins have distinct personalities. after a month, the twins are back in theatre.
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this is safa‘s brain, it looks happy... this time the surgeons will separate the shared network of veins that drain blood from twin‘s brain. but disturbing this equilibrium could also do permanent damage. a portion of each twin‘s brain is being supplied by the other twin. so there is a real risk of causing a stroke at the time of the surgery, that is something that is weighing heavily on us. there could be something down there that i can‘t see at the moment. the more the surgeons try to divide the vessels that link and nourish them, the more unstable the twins become. we're going to have to take ventilation down. 0k? down? marwa‘s heart begins to fail.
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we are not stable, but we are less unstable. good enough for me. the anaesthetists manage to stabilise the girls so the operation can continue. because marwa is clearly the weaker twin, the surgeons decide to give her a key shared vein. the operation lasts 20 hours. so i‘m relieved, i‘m relieved. i mean there was a chance we were going to... potentially lose marwa 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.
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but shortly after surgery, safa suffers a stroke. there was a period on tuesday evening where...we felt that we were very close to losing safa, and that she stayed in that critical state for... ..for 48—72 hours after the surgery. it was a very difficult time for the girls, their families and the entire team looking after them. in a break from their work at great ormond street, the two lead surgeons are in ireland to meet another set of twins. it‘s eight hears since they last saw ritaj and rital. it‘s hard to believe that these sisters, born in sudan, were once joined at the head.
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thank you! you are very welcome. back then the surgeons feared the girls might die unless separated. and this was rital and ritaj just one month after surgery. each parent able to hold a child in their arms. i hope that they will get a normal life and be treated as normal human beings. 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. so it‘s a great moment 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 time because of the conclusion.
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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 because it was done in the first year of life. what we put the two kids through and the brains through is a lot. and the younger brains and the younger circulations are better adapted. everything is easier. a one—year—old's regenerative capacities are so much better. the skin heals better, it stretches better, the bone grows in better. 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 to separate conjoined twins. it‘s january 2019. i think the last two months after their last operation
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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 and that‘s causing her a few challenges. but they‘re hanging in there. and they‘re both reasonably well. the next challenge for the surgeons is to ensure each twin will have enough skin to cover their skull when they‘re eventually separated. they do this by encouraging the skin to expand. the tissue expanders are balloons that sit underneath the skin and they have a tiny little 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 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
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so that when we come to separate safa and marwa there‘s enough skin to cover both of their heads. these are rare cases leave a lasting impact on the surgeons. 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 separated, and everyone was overjoyed and so on and so forth, and people were happy, and i looked at david and he had tears in his eyes. and he denies it to this day, but he did at that time. yeah. ithink... everybody has been so invested in this for so long. it is a surprisingly emotional thing, i think, when they finally come apart. and when that experience of them actually leaving the operating theatre as two separate people
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is quite indescribable. at last, four months since the first surgery, the day of separation. two forceps. all laid out. 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. fantastic. 0k.
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done. it's in a very emotional moment. we've been working a long 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. so we've taken them apart and now we have to reconstruct their heads. marwa is still in the operating theatre through here, while safa has been moved just next door. 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, and other vital signs. safa and marwa‘s brains used to have a distorted shape. but four months ago a plastic sheet was inserted between them and by gradually tightening
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the pressure it has largely corrected their appearance, essential before their skulls can be rebuilt. this means both teams can begin reconstruction. the patchwork of skull pieces are shared between theatres. so a piece for me, a piece for you. to have enough to cover their heads, each fragment must be divided in two. the skull is very usefully designed in three layers. 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, so you can split the bone, it‘s half the thickness, but it means we should be able to cover nearly all of the head with bone afterwards. this shows the jigsaw of bone fragments that were pieced together
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to form the skull of marwa on the left and safa on the right. the gaps have been seeded with bone cells. and in the months to come these should slowly close up. 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? everything is good. thank you. oh, what a day. they have been quite amazing 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. we asked mum who she would pick up first, whether it was safa or marwa?
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and the answer was both — with support! so, ah, yeah... the road to recovery for the twins is slow, but four months after separation, safa and marwa are beginning to make progress. # hello, safa. # 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... safa has not fully recovered from her stroke. we made the decision that the bulk
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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. they are clearly going
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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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low, fog is again a concern throughout the rest of the night and into sunday morning, lingering for some all morning. and the flood warnings are numerous across england and wales with weather warnings out that you can get on the website and it has been so wet this december as the rain makes its way into the river systems we expect those flood warnings to increase. certainly spray and standing water. look at this area of cloud. that heavy rain easing away through sunday. but this area of low pressure to the north—west still driving in showers. it is likely we will have fog issues as i said earlier, particularly northern ireland, but some of the south as well around this area of rain and ice on the north because temperatures are below freezing here. fog could be just about anywhere. the rain really drags its heels in clearing and once it clears away, brighter spells to come through, sunshine once the fog lifts and there will be a scattering of showers around that risk westerly
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wind continuing in the south taking the edge of this temperature here. decent spells of sunshine around through the second half of sunday. however, as we go through sunday night, it will continue to blow this westerly wind in, that area of low pressure close by so nothing too mild over the christmas period and nothing too chilly either. but with the westerly wind the showers continue. as i mentioned, we will see many of them gathering across northern ireland and scotland and a wintry element to them, hail and wonder through the day ahead in the showers and certainly so through the night and into monday. that continuation of heavy showers, particularly in the north. the south will he‘s off ahead of that next area of rain. the timing on that are still uncertain but likely to come in, we think, through monday night and into tuesday. so that gives us another period, wet period of 5—10, possibly 15 millimetres of rain. again on the saturated ground, nowhere else for it to go. further north, fog with lighter wind
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as well and it mayjust linger on christmas eve, that tailback of cloud and patchy rain but we are hopeful it will be a decent day for christmas eve with a lot of dry weather to be found as well. not especially warm. as we get into christmas day, the next area of low pressure starts to wind itself up and later in the day and into boxing day it could potentially bring more rain, hill snow and strong wind as well. stay tuned.
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hello and welcome to bbc news. i‘m maryam moshiri. the australian prime minister, scott morrison, has acknowledged public anger at his decision to go on holiday while his country faces a bushfire crisis. mr morrison said if he could go back he would have made a different choice. the fires are expected to worsen with more hot dry weather expected. gareth barlow reports. this is the remarkable, almost apocalyptic scene facing firefighters tackling australia‘s deadly and devastating wildfires.


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