Conjoined Twins Who Made Headlines for 2002 Separation Surgery Turn 21: Inside Their Lives Now

Twenty years after their amazing separation procedure, Teresa Cajas and Josie Hull are enjoying lives that few could have anticipated.

It was not anticipated that Josie Hull or her identical sister Teresa Cajas would survive until their first birthday. The sisters turned 21 in July.

In this week's exclusive story, Jenny Hull, the mother of Josie, tells PEOPLE, "In the eyes of the world they are both judged challenged, yet they have affected so many people." This birthday marks such a significant achievement.

The girls' friendship is now stronger than ever. According to Josie, "I adore her. Despite not being able to move or talk, she and I are able to communicate. Through our eyes, we communicate."

The sisters came to Los Angeles in August 2002 after being born connected at the head in a rural Guatemalan town in July 2001. There, a team of surgeons was able to successfully separate them during a taxing 23-hour treatment that garnered worldwide attention.

Dr. Mark Urata, director of plastic and reconstructive surgery at Children's Hospital Los Angeles, describes the technique as "extremely dangerous." The success rates for such separations "were not outstanding at the time."

But the twins quickly encountered another difficulty. They had potentially fatal brain infections after leaving and returning to Guatemala. Josie quickly had seizures and other medical issues, and Teresa eventually needed 24-hour care back in Los Angeles.

The twins' will to live increased with each setback, and their parents eventually took the difficult choice to let their daughters' American hosts adopt them. When asked how she stays in touch with her biological parents, Josie replies, "We chat every Sunday." They are really proud of us both.

Pick up this week's issue of PEOPLE, which hits newsstands on Friday, for much more information about Teresa and Josie's incredible adventure.

The sisters are now leading lives that few could have imagined, including serving as the inspiration for Once Upon A Room, a nonprofit that gives customized hospital room makeovers to kids with life-threatening illnesses. They both graduated high school in 2020 (Teresa attended a special education program).

Josie, who lives 30 minutes away from her sister in the Los Angeles region and looks back on their wonderful journey, says she still finds it difficult to understand their early adversity. I was so little, I don't remember too much, she adds. But I enjoy hearing my mother's stories since they are always somewhat surprising to me.

Florie Cajas, Teresa's mother, and Werner Cajas, Teresa's husband, are amazed by the sisters' extraordinary bond: "Josie can always draw grins out of Teresa that other people can't."

Even the twins' doctors who have treated them throughout the years are in awe of their perseverance. According to Dr. Robert Kay, director of orthopedic surgery at Children's Hospital Los Angeles, "None of this would have been possible without the care and devotion that their families have put in over all these years to maximize their potential."

Nowadays, Josie spends her time travelling throughout the nation and using her nonprofit to decorate the rooms of children's hospitals. "I think that's vital, and Josie continues, "Just be happy. And just keep going forward without stopping."
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