Siamese Twins Go Home to Land #225" By DONALD C. DRAKE Tnautrer Medical Writer SANTO DOMINGO, Domini- can Republic—The ragged lit- tle street band filled the warm evening with a scratchy Latin rhythm as one of the singers. a 10-year-old boy with a dirty shirt and forlorn voice, begged centavos from diners in tthe open-air cafe. “Dinero para la musica,” the boy pleaded again and again, as people turned tu avoid his insistent eyes, “Dinero para la musica.” e At that moment in Phila- detphia, 1,530 miles to the north, two other Dominican children were being fussed over and treated in one of the world’s finest medical fa- cilities — the ultra modern Intensive Care Unit (1C{7) of Children's Hospital. Altagricia and Clave ij. guez, the bewitching — 15- month-old Siamese “iwus, were getting even more at- tention than usual because in two days they would be dis- charged and taken back to their home in the hills, 75 miles southwest of here. Las Auyamas is 1,700 feet up in the hills, a village of reed shacks am tin-roofed huts. It is without running water, electricity or sewers, and the only form of trans- portation 18: Land = Kaver buses because ‘the roads. are frequently washed out by rain. ; Las Auvamas is where the twins live. From here, you drive in- land toward Sar Cristobal, a fading town with a decaying luxury hotel that no one seems to use anymore. Dipping south . and., then west, a macadami road car- ries you past boys riding donkeys so amaciated that their ribs are showing, and girls balancing 10-gallon ins of water on their heads. Further along, after pass- ing Bani, the roads deterio- rate, with gaping holes every 100 hundred yards or so. Ahead, though, are the strikingly beautiful Black Mountains with a thick white haze obscuring their tops. - Into the hills, the scenery becomes even more beauti- ful, with 40-foot coconut trees bordering the road. The car was soon struggling with the incline as it climbed higher, the driver taking a curve here, and hugging the road there to avoid an oncoming truck. One more turn and suddenly there is the valley, rich with green foliage and in the distance San Jose de Ocoa. Where Children Starve School nad just proken for the day in San Jose and the streets were filled with chil- dren — dressed in blue or brown uniforms. Those in brown attended Escuela Luiza Ozema Peller- ano, an attractive school with 1,000 students up to 14 years old. This is where the twins will go if they get past the first six grades taught in their school in Las Auyamas. The class rose as a unit when the strangers walked in inquiring about the Rodri- guez family. “Do you know where the twins live?” the teacher asked the class. ‘In. Philadelphia,” a girl yelled from the front row. A few blocks away was the San Jose Hospital. It has 50 beds, equipment for only the simplest surgery and a staff of five general practitioners. . It was here that the twins were born. Dr. Ricardo Ve- jazquez remembered well the caesarean section he per- Formed on Mrs. Rodriguez because she was having trou- ble delivering. * “[ reached in to bring the babies out by their feet and discovered they were con- nected,” he said, adding with understatement, ‘It was a very big surprise.” He told the father that they probably: wouldn’t survive, but they were still alive two days later so they were sent to Santo Domingo. ' Actually, there was every reason for people here to be- tieve the twins would not sur- vive. Sunday, Dec. 1, 1974 Clara and Altagricia” Rodriguez _ _ They come from a country with an average family in- come of $430 a year, where 70 percent’ of the citizens are malnourished and, therefore, Susceptible to disease, and where the life expectancy is $8 years, compared to 70 in the United States. , The infant death rate is 50 per 1,000 live births, almost three times that of the United States, and 46 percent of all deaths occur among children under four. ‘ Whooping cough, measles, fetanus, tuberculosis and diphtheria are all major child killers. But underlying most of the illness is malnourish- They come from a country vith an ‘average family in- ‘ome of $430 a year, where 0 percent‘of the citizens are aalnourished and, therefore, usceptible to disease, and vhere the life expectancy is 8 years, compared to 70 in the United States; The infant ‘death rate is 50 der 1,000 live births, almost three , times. ‘that of the Jnited States, and 46 percent xf all “deaths occur among children under’ four. Whooping cough, measles, etanus, ~ tuberculosis and liphtheria are all major child illers. But underlying most ff the illness is malnourish- nent. _It makes the children sus- -eptible to internal disorders, lraining water from their tis- ues, forcing them to vomit nd eventually killing them ‘ecause of dehydration. Diarrhea, which is not a vediatric - problem in the Jnited States, accounted for 0 percent of all Dominican leaths — child and’ adult ‘— A197 At the Robert Reid Cabral lospital, fhe 310bed chil- ten’s hospital in Santo Dom- ngo where the twins were aken two days after their virth, the: Rodriguezes were ‘old that little could be done or their daughters in the Do- ninican Republic. The coun- ry’s medical. system just couldn’t handle it.. “The medical director at the tospital is Dr. Hugo R. Men- loza,_a soft-spoken man with entle eyes and a slight air f sadness. The government avs him $300 a month as iedical director, so in the fternéons he “keeps private fice’ hours —° a common ractice here. Dr. Mendoza was giving a siter a tour of his hospital. ‘hen he got to the swinging rors of the emergency iom, he paused. “What do uu. say. in. English?” he iked. “Ah yes... Here is ir Dante’s Inferno.” Dramatically, he swung yen the double doors. Inside ere 30 crying, moaning ba- ies. They were lying on five ong tables, a half-inch board eparating “one from the text. Long Tables’ On one side of the long ta- Stan same the matherc On the other side, hanging from overhead pipes, were the bot- fles of dextrose. A tube led from each bottle to the fore- head of a child where it was limpMantéd ina vein. $ Dghydration. These were the babies who were so sev- erely dehydrated by their diar- thea that they needed emer- gency: care or else faced the likelihood of dying. One case 2 wéek like tsis would be un- usual;in the United States. Herg, there were 30. 2 Marly months earlier, when ‘She :twins arrived at Chil- ren§*; Hospital for their op- eration, they, too, were somewhat dehydrated, ane- mic “and had vaginal infec- tions: In the future; though,. the twins. should be better off. They Ewere given every’ im- mmunization’ known at. Chil- Slren’¢ Hospital, and Dr. C. Everett Koop, who led the Surgical team that separated them. -has made special ar- ‘Assistance. Program, a non- rofit organization running ‘health and food programs in ‘82 countries, for the twins to Ret vitamin and protein sup- plements, * £ Ver few. Americans, of ‘course, get the kind of medi- cal attention the twins re- ceived in--Philadelphia.. For ‘82 days, until their release on! yangements with the Medical’ Thanksgiving, they were watched constaritly by one and sometimes two highly trained pediatric nurses. Ultra-Modern Aid The most modern medica] equipment and a skilled team of surgeons, physicians and nurses were required to Separate them in an opera- tion that took 10% hours. - The cost was all donated. But under ordinary circum- Stances the fee would have been $200 a day per child, or $32,800. And that doesn’t count the cost of physicians ‘and ancillary services..." r By way of contrast, there: ‘is the 300-bed Hospital Dr.’ Dario Contreras, the only or- thopedic hospital in this -ountry and thus the facility to which the twins will be sent if they suffer any seri-’ ous bone-related maladies. It is one of nine hospitals here \o offer free medical care for the poor, and most natives are poor. ‘ Only recently has it in- Stalled an intensive care unit, but, it is equipped with none of the beeping elec- tronic monitors, suction pumps or oscilliscopes com-. mon in the United States. “The only thing we mont- tor here is blood pressure,” said Dr. Donald W. Ross, of California, a CARE doctor teaching orthopedic surgery to Dominican physicians. Dr. Ross stode past the rooms full of patients, joked with a couple of men who were in traction, saying something in broken Spanish, and then went down the Stairs to the Sala de Ninos, the pediatric ward. Strangely Quiet The unit was strangely quiet, for malnourishment makes children quiet. One room had 10 cribs, and al- most every one of them con- tained a child with a cast on one of the limbs. “Osteomyelitis,” Dr, Ross explained, holding an X-ray film up to the light. Even an untrained eye could see the gauges and holes -in the bones. Osteomyelitis, a sev- ere infection of the bones, is not a major pediatric prob- dJem-in the states, but mal- nourishment impairs a child’s ability to fight off the infec- tion which eats the bones. Another room was filled with children with big bel- lies, spindly arms and huge pleading eyes, the hallmarks of the malnourished. Many of the children had burns, another common problem be- cause open fires do the work of the safer electric or gas etnvupe weed in tha TMhnited At the hospital in San Jose, where the twins were born, the people said it would be difficult for the strangers to find Las Auyamas. So some- one came along to guide. Hard surfaced road had dis- appeared by now, replaced by a gutted dirt road. The beauty was breathtaking. Royal palms, as high as six- story buildings, reached up into the sky with huge white birds perched on the heavy leaves. Cows stood on the hillsides at what seemed like impossible inclines eating grass. Wooden shacks with brightly colored walls popped up in clusters here and there. A two-foot deep pocket of water cut off the road near Las Auvamas and the last half mile to the Rodriguez house was made on foot. On all sides, reaching steeply upward, were the lush hills, almost obscuring the sky. Here and there were coffee bushes or an orange tree or heavy palms. Smile of Welcome The twins’ father was standing at the counter of his open, roadside produce store. Recognizing me from his trip to Philadelphia, his eyes opened wie in surprise and his face filled with a huge smile. The twins’ house is made of wood with a concrete floor and a corrugated tin roof. The walls are bright green with red trim. On one wall is a picture of Dr. Koop. The house consists of two small bedrooms, a small liv- ing room and a_ kitchen. There is no electricity, no sanitation. The twins will sleep with their parents, The other five children sleep in the second bedroom. Still, the house is neat, more substantial than most in the small, isolated com- munity. . Many people leave Las Au- yamas to work in Santo Domingo or Puerto Rico, but most return when they have some money. It is home and they like it. There are no locks on the doors, and the people all know each other. They travel to San Jose on weekends when there is a good band in town. Sickness, Poverty There is sickness and pov- erty., In August, when it be- comes very hot, diarrhea strikes and sometimes a, child dies. Six months ago, one of the babies died of diphtheria. But the people here say there is also love and friendship. It seemed incredible that ' from this remote part of the world, the word of the Siamese twins.could spread to Philadelphia. It had passed through a line of rela- tives to Puerto Rico, and then to Mrs. Diana Zimnoch of Warrington, who brought it to Dr. Koop in Philadel- phia. ; And now, one day before Thanksgiving, the day the twins would be released from the hospital, Rodriguez asked | about his famous daughters. ° He knew that ‘Ladies Home Journal was going to pay $10,000 for exclusive rights to - their, story. But .he didn’t know ‘that, they would be re- turning in-only. a few more days. — an He said he hopes to use the money for a house in San Jose. He’d keep the business in Las Auyamas, and com- mute on weekends by Jeep bus, By now,-night was begin- ning to fall, the moon clearly visible in the poor village with the green house. ‘It was hard to grasp that the same moon was shining in Philadelphia.