They were born with their heads fused together, but more than two years after being separated at the Singapore General Hospital, the Nepalese twins Ganga and Jamuna Shrestha can neither walk, nor talk, nor do many of the things normal toddlers take for granted. 'Before the operation in April 2001 they seemed like normal children,' said their worried mother Sandhya Shrestha. 'But it's different now, and we're anxiously awaiting word from Singapore about their further treatment.' On May 9 the two girls celebrated their third birthday. But Ganga remains confined to her pram - she cannot sit up or utter a single word, sleeps most of the time, and has problems with her bladder and bowel movements. Jamuna is the brighter of the two girls, but even she utters just a couple of words at a time, and cannot stand or walk, but instead pivots her frail body on her arms to move like a paraplegic. 'Ganga's brain was infected during surgery, that's why she is retarded and will never be fully functional, she will always need special care,' said Basant Pant, the neurosurgeon on the Nepali medical team who has been monitoring the twins since their return from Singapore. 'Jamuna, though, should be able to eventually lead a normal life, and even go to school.' 'But both need further surgery,' he added. 'Ganga's brain is too large for her head, so her skull needs to be reconstructed to relieve the pressure. Jamuna's skull has a bone defect, so she needs surgery too, besides cranoplasty to improve the shape of her head.' When the twins left Singapore around seven months after they were separated, the parents were told that further surgery would be done about 18 months later, or around April this year. Money was not an issue, since Singaporeans had donated generously for their treatment. Reports at that time said around S$360,000 (HK$1.6 million) was collected, though the girls' mother insists the amount was more like S$650,000. Ganga and Jamuna were operated on by a team of doctors led by Keith Goh, recently again in the news for the unsuccessful effort to separate the Iranian twins Laden and Laleh Bijani. But Dr Goh, who visited the Shrestha sisters in Kathmandu a year ago, has since moved to Raffles Hospital, while the fund meant for their medical care is still controlled by the Singapore General Hospital. 'There's considerable money left, so it's high time the medico-political problems are sorted out and treatment resumed,' said Dr Pant. Just like the Iranian conjoined twins, Ganga and Jamuna also had separate, anatomically intact brains lying within a single skull case. But they were joined at the top of their heads, their brains intertwined like a helix, while the Bijani brains lay side-by-side within the skull. What may have made the difference between life and death for the Shrestha sisters, though, is the fact that they were just 11 months old at the time of the 88-hour operation, and not adults like Laden and Laleh. Ganga and Jamuna, named after two great Himalayan rivers that merge and flow into the Indian Ocean, are rare in many ways. Conjoined twins are often still-born. Twins joined at the head, a condition known as vertical craniopagus, occur only once in every two million live births, and successful separations are extremely rare. Before Dr Goh operated on the Shrestha girls, only four attempts had been made worldwide to separate such twins: only one was successful. So when Ganga and Jamuna returned from Singapore seven months after they were separated, they were treated like national celebrities in Nepal. 'People saw it as a miracle,' said their maternal grandfather Arjun Dev Shrestha, a retired school-teacher. 'We were full of hope, believing that the girls had a good chance of leading normal lives.' Ganga's transformation, though, is a warning that the girls face even more challenges when separate than joined together. Before the operation, Ganga was the stronger of the twins, and the more active, vigorously scissoring the air with her hands and legs. Ganga has turned passive and unsmiling, crying out only when in pain, while Jamuna, though still delicate of build, shows signs of developing normally, as she sways to the Bollywood songs blaring from the TV, grabs a visitor's mobile phone, or puts her hand reassuringly on her ever-sleeping sister. And she cares. When her mother got her a pair of silver anklets, Jamuna would wear only one, insisting that the other be put around the ankle of the comatose Ganga. But when the girls' maternal uncle returned from a temple with an auspicious black thread, it was tied only around Ganga's wrist, for it is she who most needs the luck. 'It's scary sometimes to watch her, almost as if her life is ebbing away,' says her maternal grandmother Ambika Shrestha. 'And on some days when her urine doesn't flow for up to nine hours, her hands and feet begin to tremble, and she cries in agony. Then we rush her to a clinic, and the urine is taken out with a catheter.' But even the comparatively healthy Jamuna has to be kept under constant watch in order to ensure that she does not suffer a head injury by any sudden, rough movement. After the two girls were separated, Gortex, a synthetic material used in raincoats, was substituted for the missing layer of tough tissue, the dura, that covers the skull. Their heads were also patched up with a mixture of tiny bones and a strong glue, all of which has made them more vulnerable to head injuries than other children. The girls also need specialised medical attention, available only in Kathmandu, so the entire family - mother Sandhya, father Bhushan Shrestha, along with the maternal grandparents - has temporarily shifted from their mountain village to a modest, rented apartment in the Nepalese capital. The girls' father has a small and not-so-lucrative business retailing textiles, so the meagre monthly income of 4,000 rupees (HK$430) from the mother's job as a primary school teacher goes a long way in supporting the family. But now the mother, who was on transfer to a school in Kathmandu, has been ordered by the authorities to go back to her original job in the village school. 'The government wants me to either abandon Ganga and Jamuna, or give up my job and income,' she said. 'I can't afford to do either for the sake of my children.' Out of desperation, the mother petitioned King Gyanendra last week, pleading that she be allowed to keep her job and stay with her children in Kathmandu. 'Everyone here thinks we're rolling in money because of what was collected in Singapore,' said the grandfather, Arjun Dev Shrestha. 'But that money's not in our hands. In any case, there's just one thing we want desperately, and that's to be able to take the girls at least once back to Singapore for the treatment that was promised after the operation.' The promise of a normal and healthy life made to the conjoined twins at the time of their much-publicised operation has only been partially fulfilled. Now the Shresthas want to ensure that the separated Ganga and Jamuna are given a second chance to grab at that elusive dream - a miracle of medicine.