PNG hospital says anyone prepared to take on conjoined twins 'must be willing to take on' the risks
Conjoined twins Tom and Sawong were born on October 7. (Supplied)
In short:
The parents of conjoined twins in Papua New Guinea are still trying to explore options to get them surgically separated after their current hospital advised against it.
The family had initially hoped to come to Sydney for treatment, but is now looking into going to Germany as an alternative option.
Doctors in PNG say they are not stopping anyone from taking on the case, but they must be prepared to deal with the risks.
The mother of a rare set of conjoined twins is begging doctors to explore other options after a Papua New Guinea hospital said it was too risky to send them overseas for surgery.
Fatima Tinga, who gave birth to twins Tom and Sawong nearly a month ago, fears one or both of her children will die if they remain in the country.
"I am worried about my two babies," she told the ABC.
"If one baby dies, how will the other one survive? If they are separated, [I believe] one will live. But if one dies and they're still joined, how will we separate them?"
Fatima Tinga says she is worried the twins will not have enough support in rural PNG. (ABC News: Marian Faa)
Tom and Sawong were born on October 7 in the remote Morobe Province, joined at the abdomen, and were airlifted to the country's capital, Port Moresby, for further care.
Conjoined twins generally have a low survival rate and, in most cases, medical teams will try to separate them for the best chance at survival.
Doctors at the Port Moresby General Hospital, where the twins are being treated, initially explored the possibility transferring the twins to Sydney for specialist care.
But the hospital is now recommending against sending them overseas.
Director of Medical Services Kone Sobi said the decision was based on clinical assessments by a multidisciplinary team, including extensive consultation with doctors in Sydney and Melbourne.
"We feel that even with care and treatment in highly specialised units, the chances of survival are very, very slim," Dr Sobi said.
"Based on that, we feel that both twins will remain with us and we will continue to provide care as long as possible."
The twins share a single liver, bladder and parts of their gastrointestinal tract, and the smaller twin, Tom, has a congenital heart defect and issues with his lungs.
"Perhaps one of the twins is doing a lot of the work in terms of the supplying of oxygen and even for the heart for the other one," Dr Sobi said.
"They are small. They need to be fed. They need to be provided an avenue for them to grow before they can actually intervene surgically."
He said the hospital's focus was on supplying nutrition to the newborns and protecting them from infections.
The twins share a liver, a bladder and parts of their gastrointestinal tract. (Supplied)
'They're not going to get better'
Ms Tinga said she still wanted to explore other options for sending the twins abroad, fearing her sons had little chance of surviving if they were to remain in Papua New Guinea.
She said Tom, the smaller twin, was showing signs of improvement after he cried and recorded an increase in his oxygen saturation levels.
The family is now in contact with a hospital in Germany to see if they can get specialist treatment there.
Jurgen Ruh, the pilot who flew the twins to Port Moresby, has been helping the family explore options to go overseas for further medical treatment.
He said, despite the risks, the family wanted to keep pursuing surgery so that they knew they did everything they could.
Jurgen Ruh says the twins will not get better without medical intervention. (ABC News: Marian Faa)
"If the children remain where they are, it is a question of time before they die. If you do nothing, it's a question of time before they die," Mr Ruh told the ABC.
"If the children die in a hospital in Germany — and [with] good hospital resources of equipment and personnel … we can say: 'At least we tried.'
"But if you don't try, they're not going to get better on their own."
Port Moresby General Hospital CEO Paki Molumi said the hospital would not provide a referral, but it would supply medical records and other documents if requested.
"It's not the end of the road," Dr Molumi said.
"[We are] happy to support any organisation … willing to take on this case, to take [the twins] to any facilities, anywhere around the world.
"But as far as our clinical advice is concerned, that is a risky path that you are taking, and you must be willing to take on all the risks and responsibilities that go with doing that."
Australia says government funding 'not an issue'
The Australian High Commission in Port Moresby said the federal government had been "working in the best interests of the twins, guided by their medical teams".
"Australian government funding has not been an issue," the statement said.
"Our thoughts are with the twins, their parents and their family at this time."