Former conjoined twins celebrate 21st birthday after being separated in risky operation 20 years ago

Josie Hull and Teresa Cajas, who were conjoined at the head before being separated, turned 21 this year. The twins were born in July 2001 and were separated a year later in 2002 in a risky 23-hour operation. July 2022 marks 20 years since the twins were separated and it was a milestone that many didn't think they would make. Hull and Cajas come from a small village in Guatemala and they made the trip to Los Angeles to undergo the high-risk operation. The separation surgery was conducted at UCLA in 2002, reported KABC. The conjoined twins were joined at the head, a condition that only affects one in every 2.5 million babies.

“Josie and Teresa shared a blood supply because they were connected at the brain. The brain tissue had to be separated,” explained Dr. Mark Urata, an oral and plastic surgeon at Children's Hospital Los Angeles who was part of the team that operated on them. “To watch them grow independently and to thrive has been probably one of the greatest joys of both my personal and professional life,” said Urata.

It hasn't been a linear recovery for the twins, as both Hull and Cajas suffered brain infections, leaving Cajas with permanent brain damage and Hull with complications that include seizures. It became apparent that Cajas required near full-time care in Los Angeles. Hull also needed care due to medical complications. Their parents made the heartbreaking decision to allow their daughters' American hosts to adopt them. They still keep in touch every Sunday, says Hull. "They're really proud of both of us," she said. The sisters live 30 minutes from each other in Los Angeles. Hull says she can't recall any of it as they were 1 year old at the time, adding that her mother often tells the story to her.  

The children went on to live with two different families but still connect on important milestones such as their 10th birthday, quinceañera and now, their 21st birthday. "In the eyes of the world they're both deemed challenged, but they've touched so many lives," Josie's mom, Jenny Hull told PEOPLE. "This birthday is such a huge milestone to celebrate."

Cajas' Mom, Florie, says her child and Hull share an amazing connection. "Josie can always get smiles out of Teresa that other people can't," said Florie. Dr. Robert Kay, chief of orthopedic surgery at Children's Hospital Los Angeles, says the 21-year milestone is due to the care of their respective families. "None of this would have been possible without the care and love that their families have put in over all these years to maximize their potential," he said.

Today, Hull runs a nonprofit called "Once Upon a Room," which she started with a friend at the age of 12. They decorate hospital rooms of pediatric patients in 20 hospitals across America. “They’re an inspiration to the medical teams helping them,” said Urata in 2016, reported Newswise. “At the time, separation surgery was uncommon, and the prognosis for conjoined twins like Josie and Teresa was uncertain. If one gets ill, the other could get sick too, so the statistics aren’t very strong for having a long life as conjoined twins. I think the separation has been a life-altering experience for them,” he added.