By Sam Relph and Peter Foster in New Delhi
An Indian girl born with four arms and four legs is to undergo a 40-hour operation tomorrow as doctors try to give her a chance at a normal life.
Lakshmi Tatma is a two-year-old girl named after the Hindu goddess of wealth who has four arms. She was believed to have been "sent from God" when she was born to a poor rural family in the Indian state of Bihar.
mother, Poonam, as she waits for her operation
As news of her birth spread among the 500 inhabitants of Rampur Kodar Katti — a remote settlement without electricity or running water — men, women and children queued for a darshan, or blessing, from the baby.
However, it will require the latest techniques in medical science to separate Lakshmi from her "parasitical", headless, undeveloped "twin", which is joined to her body at the pelvis.
The £100,000 operation will require differently skilled teams of more than 30 surgeons to work in eight-hour shifts to separate Lakshmi's spinal column and kidney from that of her twin.
After attempting to transplant the shared kidney wholly into Lakshmi's body, another team of surgeons will gradually close up her pelvic girdle while re-orientating her bladder and genital systems. Plastic surgeons will then graft skin to cover her wounds while an "external fixator" will be attached to close her pelvis gradually over a three-week period.
The procedure has been described as "like shutting an open book".
Without the operation at the Narayana Health City, on the outskirts of Bangalore, Lakshmi's parents were told their daughter was unlikely to survive beyond early adolescence.
After more than two months of preparation, Dr Sharan Patil, the consultant orthopaedic surgeon leading the operation, said that her team was reasonably confident that the procedure would succeed in helping Lakshmi to survive.
"Fortunately, Lakshmi has one complete body with a near perfect set of internal organs," she said.
"Her skeletal system involves two bodies which are fused together at the level of the pelvis.
"The operation itself, although it presents several challenges, is not the most complex in the world. What is highly unusual in Lakshmi's case is precisely how her bodies are fused, almost mirroring each other."
bodies are joined at the pelvis
Her mother, Poonam, and father, Shambu Tatma, who earn about 50p a day as casual labourers and are both in their twenties, were turned away by a government hospital when they asked for help to increase Lakshmi's chances of survival.
However, they were brought to Bangalore after Dr Patil visited their village.
"We tried to take Lakshmi to hospital but they turned us away and said nothing could be done," Mrs Tatma said yesterday. "We saved money and even went to Delhi but the hospitals there turned us away too. Lakshmi had never once seen a doctor until Dr Patil came to our village and took an interest in our case.
"I believe that Lakshmi is a miracle, a reincarnation, but she is my daughter and she cannot live a normal life like this."