Two months after being separated in a six-hour surgery (November 2018), twins Nima and Dawa continue to amaze and inspire medical professionals, carers and family as they reach motor development milestones that will soon see them toddling.

Clinical physiotherapist Katie Hatton, APAM, says it’s exciting and rewarding to see her young patients respond to rehabilitation and move a little more each day. ‘They are very curious and resilient girls, very cheeky,’ Katie says of her charges, who were born joined at the torso and sharing a liver. ‘With their personalities it helps motivate them to make these improvements, as well. Nima has been consistently the stronger twin and reaching milestones before her sister, but they are both progressing well.’

Katie is a member of a small team of physiotherapists who volunteer with the Children’s First Foundation (CFF), a Victorian-based charity that helps rehabilitate disadvantaged children from developing countries who have undergone life-changing surgery in Australia. CFF brought the girls, their mother and a Bhutanese nurse to Australia in October. A month later the then 15-month-olds underwent a life-changing operation at The Royal Children’s Hospital. Remarkably, 16 days after the crucial effort to separate and reconstruct their individual bodies, they were discharged to be cared for and undergo physiotherapy with Katie and the team at the foundation’s Miracle sMiles Retreat in Kilmore, north-east of Melbourne. Katie became involved with CFF through her work at St Vincent’s Private Hospital (SVPH) Melbourne.

‘There were already a few therapists volunteering their time to work with a number of children pre- and post-complex surgeries, but more therapists were needed to help with the caseload. So, I decided to volunteer my time as well,’ she says. ‘I assisted my manager with a yoga class for the children a few months ago, and a little time later an opportunity arose to work with Nima and Dawa. I agreed to see them on a weekly basis to provide guidance to their mother, Bhumchu, and CFF staff and students on how to progress their motor skills to help reach their milestones.’

The physiotherapy team has been integral to the twins' journey and recovery, and Katie is proud of her peers’ efforts in helping transform their lives. ‘Being part of such a high-profile and medically complex case was a little overwhelming with the media attention,’ she says, ‘but at the same time really rewarding observing the impact physiotherapy can make on a child’s quality of life. The twins’ case is well known, but there has been amazing work done for other children supported by the foundation—be it the surgery itself, care received from staff or their rehabilitation journey post-surgery with fantastic physiotherapy input from my colleagues.’

A senior physiotherapist at SVPH coordinates the post-surgical visits to CFF, those of volunteers from the hospital or, on occasion, outsourcing locally, with each patient gaining strength, independence and confidence as a result of their efforts. ‘I visit them face-to-face on a weekly basis, observing their functional progress, and demonstrating and providing advice on exercises to Bhumchu and CFF staff in the form of play, and will continue to see them on a fortnightly to monthly basis until they return home,’ Katie says. ‘A second-year undergraduate physiotherapy student who attends the retreat three times a week has a real knack for working with children and has also been implementing the game-based exercises suggested.’

The twins’ progress is measured using the Alberta Infant Motor Scale. ‘Compared with their age-related peers, it’s not surprising they have had a bit to catch up on, as it would have been impossible to roll or crawl being conjoined at the torso. The scale has helped create therapeutic goals for each of them, such as how to sit unsupported and transition into a four-point kneel independently, within a certain timeframe,’ she says.

‘A really good resource I also have used for the twins’ therapy is the book Positioning for Play, as it contains many fun-based activities that focus on motor development in various positions, such as lying, sitting, kneeling and standing. Through the use of toy placement, a child can be enticed to roll, crawl, stand and cruise along furniture, which is how I approached my treatment with the twins. It’s been a positive and rewarding experience as there have been significant improvements seen with the girls’ motor development and subsequent quality of life.’

Katie finds clinical work stimulating, rewarding and enjoyable, possibly made more so after her tenacious efforts to pursue a career in physiotherapy after narrowly missing out on a place in the La Trobe University course post her VCE studies. ‘What I find most appealing about my role is observing improvements made to a person’s function or quality of life from physiotherapy intervention, and empowering them to have better control over their health. Whether it be from education, manual therapy or other treatment modalities, I find these changes in function and health beliefs most rewarding.

‘I knew I really wanted to work as a physiotherapist, [but] I missed out by a couple of points with my VCE to enter into physiotherapy directly, so I then decided to go to La Trobe University and study a double degree in nursing and midwifery. I completed the first year of that degree, and worked really hard to achieve the results I would need to help transfer across to a Bachelor of Physiotherapy. I’m sure the School of Allied Health thought I was a pest, because from what I can remember I was in contact with them almost every day at the end of second semester asking them about the progress of my application of transfer to physiotherapy.’ Katie’s persistence paid off, and in 2008 started her degree in physiotherapy. ‘All up I was at university for five years, but I’m glad I studied a different area of health prior to physiotherapy as it gave me an appreciation of how nurses, and other disciplines, function within a team.’

During her studies Katie worked as an allied health assistant with The Royal Children’s Hospital, and on graduating worked for two years at Barwon Health before travelling and working in the UK. On returning to Australia in 2015 she secured some work at SVPH and worked for the Royal Darwin Hospital for 18 months. She credits a high school friend-turned-midwife in encouraging her to take a leap of faith and test her skills in acute settings, particularly in paediatrics.

‘I was somewhat apprehensive about going [to Darwin], as I had very little experience in the acute setting at that time … it really broadened my skillset, along with the hospital’s strong support for internal and external professional development. I learnt so much, which has helped shape the physiotherapist and person I am today.’

A colleague at SVPH continues to inspire her to ‘seize opportunities’, and she says the support network offered by peers and supervisors is invaluable, particularly when dealing with complex clinical cases.

‘When I was working in the UK, I spent some time working on an oncology and haematology unit, working frequently with palliative patients. One patient I remember was the same age as I had been, but terminally ill with a painful cancer. It had been confronting at first but I took ease in knowing I was doing my absolute best for that patient, aiming to make the end of their life as comfortable as possible.

Seeing cases like that really puts life into perspective. It stops you from focusing on the more trivial problems, and helps you appreciate all the good things you have in your life. That was a strategy that often helps me. I think the same applies with helping children—you can only do your best for them with the knowledge, skills and resources you have available. In saying that, as physiotherapists we are only human and it is okay to seek support from a supervisor or professional should clinical work become emotionally distressing.’

Katie is looking forward to continuing in clinical paediatrics, including with CFF. ‘Being involved with these charities makes you realise that there are so many people willing to volunteer to improve the quality of life for so many … it is an incredible experience and very rewarding to help others. It is the first time I have dealt with conjoined twins and it has been a wonderful journey.’

For more information about Children’s First Foundation visit www.childrenfirstfoundation.org.au.