Unidentical Twins

Normally when you think of identical twins you think of two parallel lives. Two people that have a connection that the rest of us simply cannot understand. Two people who have the same DNA, the same potential and generally a similar outcome. I always thought of twins as people who had a strange telepathic connection and were mirror images of each other. Since twins are generally raised in the same house I feel like it’s rare to see twins that look like night and day or are on different learning levels.

Recently however I learned that this perception I had is entirely false. Identical twins can look as different as fraternal twins when you toss in some chronic malnutricion. I had heard about the malnourished twins from one of my annexes in Tamno but silly me I thought that both of the children were malnourished not just one. I thought that they were suffering from the same fate but I could not have been more wrong.

I went up to Tambo seeing the two twins side by side for the first time. They appeared so different I did not in fact realize that they were twins until my health post told me. They are identical females a year old, Luz Maria and Luz Esperanza. Luz Maria, is reisgo bajo de talla, a little short for her age, but relatively on track for a community where nearly every child is suffering from some sort of malnutricion. She walks around with pudgy baby limbs and giant chipmunk cheeks. She has the curious look of a one year old trying to explore the world. She will stare you in the face while eating her apple, make eye contact with you and wonder off to find something else more intriguing.

There is a distant dullness present in her eyes. A sort of deep dullness that is barely recognizable. A faint hint that she is not to her full potential but none the less when she looks at your face you get the feeling that she knows what she is looking at. Even though there is the distant dullness present in so many of the children here Luz Mariacan walk and crawl and hold her head up straight. I wouldn’t be surprised if she started to say a few words, or sounds that may appear to be words in the near future.

Her sister, her identical twin sister, Luz Esperansa, who until the moment I saw her I assumed looked exactly the same as her sister is chronically malnourished. She is without a doubt the skinniest baby I personally have ever seen. When I was touching her hands I felt like I was touching the hand of a preme rather than a one-year-old baby. Also unlike most one year olds she did not really react to my fingers. It was if she was touching it but not trying to grasp it. Instead of trying to make a decision of what to do with the finger placed in her hand she simply let her hand slide away, almost as if my finger had never come into contact with her skin.

The look in her eyes is so vacant and distant it is as if there isn’t even a human being behind it. She stared off listlessly into space clearly not having any idea what she is staring at. Her face is so disproportionally small to her eyes that it looks as if her eyes may pop out of her head at any given moment. Unlike her sister who has chipmunk cheeks compliment her giant eyes, Luz Esperanza’s face is sunken under her eyes and her cheeks lay flat against the bone. The limbs of her body look as if they could break at any moment because there is not a protective layer of fat and muscle to surround the bone that lies underneath.

Apart from the vast physical discrepancies that are undoubtedly visible, there are other more startling and more dramatic differences between the two. There is a schism the size of the Grand Canyon present in their developmental skills. Luz Esperanza cannot dream of holding an apple yet, I doubt she could even hold a feather at this point. In fact she has barely even mastered the art of holding her head up straight, crawling or controlling any muscle motion. Her head is perpetually bobbing to the side as if it is too big for her tiny neck. Her head will stably sit up for about 30 seconds before her entire body flops, wiggles and her head looks as if it may break her neck. In fact, I never saw Esperanza even sit up on her own. When she was in the seated position either her mother or her sister perpetually supported her and her body movement is so floppy and jerky that she didn’t appear that she had any control over what she was actually doing. It was as if her persistent and dangerous sounding cough could cripple her body and force her crumble and fall to the floor because there was no brain to muscle connection.

Throughout training I heard about the difference in development between nourished children and malnourished children. My health post has discussed it incessantly during meetings of Programa JUNTOS in an effort to mejorar the situacion de salud in Cusicancha. It has always been a fact of life here; I have seen the dull distant look of mildly malnourished children in many of the children here. I have gone to the coast and thought that children were a solid 2 years older because they were so much larger than children in my site but there was something about seeing twins in such shockingly different states of mutricion and development that shocked me.

It left me to wonder how such a thing could happen, how to one-year-old twins end up in such a position of disarray? It is not as if one is a boy and one a girl, which I could understand because of the machismo culture. These are two girls, not even old enough to talk or make decisions. Is it that the mother simply chose one child over the other? Picked a favorite and decided to feed it better. Could it possibly be that she already has 8 other children and simply could not manage 2 more at the same time so one’s life fell to the wayside? Could it be as simple as one child was more demanding that the other so she won the perpetual food war over meager resources. What is it that leads to one twin having a future and other appearing that it may not make it though this exceptionally cold winter?

This made me wonder about the future of the children. What their life will be like as they grow older and recognize their vast developmental and physical differences. Already one child is walking before the other, soon she will be talking, running, giggling and making friends before the other. It made me think that they will be more like sisters than twins. The telepathic connection and secret languages I always envisioned twins having may never come to fruition. How can you have a secret language if one starts to talk nearly a year or more after the other? Will one child have to constantly look after her smaller; less emotionally, socially, and mentally developed sister? On a serious note will both of the twins survive to their 5th birthday?

It was starting to see the comparison of nourished to malnourished child side by side. Generally it is a far off concept, one kid is one the coast and one in the sierras so the comparison is too far apart to have a clear picture or the children are already at different ages so it is hard to say what is age and what is nutricion. But with twins the difference was undeniable. There was a clear picture in front of my face of what malnourishment does to a child. How malnutricion is devastating to a child’s future and the first three years of like can do irrecoverable damage. It leads me to wonder if this was a moment of Sophie’s choice where the mother only had enough for one or one twin genuinely trumped the other. Nutricion has shown itself to be the clear dividing factor between two people that had the same exact potential tearing apart two lives that had the potential to be bound together for all eternity.