This third hand of a boy from Nepal is an ugliness that presented his parents with a painful choice that can lead to paralysis of the baby.
A hand that doesn't move - the remains of Gaurab Garum's undeveloped twin - grows from a crevice in the baby's spine.
A cleft known as spina bifida (spina bifida) occurs in one in 1,500 babies - but the extra arm is much less common. As she continues to grow, she is already beginning to influence Gaurab's sleep and his mother, Kalpena, worries that her son will soon be unable to put on the T-shirts.
Now Kalpena and her husband Ashish have to make a very difficult decision about whether or not to remove the fifth limb - knowing that such an operation could lead to Gaurab's paralysis.
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Family lives in an extremely religious Hindu community and local medicine men tell parents not to go to doctors. The father says, "People said the boy was a form of God and gave us money."
Kalpena adds: “Some said that the operation needed to be done and the boy had to be taken to the hospital. Who should we listen to? What do we need to do? We couldn't decide."
“For treatment we went to the palace of the medicine man. He said there was no need to get rid of the hand. If you delete it, it could end up badly for you. He said that God gave it to you, so you need to accept it and keep it."
Seeking advice, the family embarked on a 220-kilometer journey south to the capital city of Kathmandu and the Grande International Computed Tomography Hospital.
The local orthopedic surgeon Dr. Chakra Raj Pandey says the extra arm itself is not a problem. Spina bifida is a major concern for doctors.
However, Gaurab's spinal nerves can also be damaged by surgery to remove his third arm - possibly leaving him paralyzed.
No option is without risk, and therefore it is extremely difficult for a family to make a choice.