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Wenceslao Quiej Lopez plays with his daughter, Maria Teresa, as she gazes at a musical toy ball.<

Maria Teresa Quiej Alvarez, one of the formerly conjoined twins separated at UCLA last year, is in critical condition in a Guatemalan hospital.

On April 15, doctors discovered a pump they inserted in her skull had become infected with E. coli bacteria.

Doctors at the Hospital del Pilar in Guatemala City successfully removed the old pump, inserting a new device to keep liquid from pooling and putting pressure on her brain.

“The good news is that Maria Teresa’s condition has improved significantly and she is doing much better,” said Dr. Jorge Lazareff, director of pediatric neurosurgery at UCLA’s Mattel Children’s Hospital.

Lazareff and a team of UCLA anesthesiologists traveled to Guatemala on Monday night to consult on Maria Teresa’s case after being invited by Dr. Ludwig Ovalle, medical director of Guatemala’s Pediatric Foundation.

Dr. Barbara Van De Wiele and Dr. Swati Patel, who led the team of UCLA anesthesiologists during the 23-hour separation surgery last August, accompanied Lazareff to Guatemala.

Despite the setback with Maria Teresa, Lazareff maintains his confidence in the quality of care the separated twins are receiving in Guatemala.

“We hold the utmost trust in our colleagues from Guatemala and know they are providing Maria Teresa with the best of care,” Lazareff said in a statement last Friday.

“The treatment she is receiving is appropriate, and her pediatrician, Dr. Ludwig Ovalle, is an excellent pediatrician,” he continued.

Lazareff and the team of anesthesiologists are scheduled to return to Los Angeles on April 30.

Since the separation surgery last August, Maria Teresa has recovered more slowly than her sister, Maria de Jesus.

Maria Teresa has required three additional surgeries to remove a buildup of blood in her brain. She also suffered hearing loss in one ear and wears a hearing aid.

This is also not the first time UCLA doctors have traveled to Guatemala since the twins returned home on Jan. 13.

A seven-person UCLA medical team, which included Lazareff, traveled back to Guatemala with the twins to oversee their transition after they were released from UCLA.

UCLA medical specialists recently made several trips to Guatemala to provide medical services to dozens of children suffering from neurological diseases, as well as to help train local doctors.

In March, Lazareff and two doctors reunited with the Quiej Alvarez family in Guatemala during one such volunteer medical trip.

The twins arrived at UCLA on June 7, 2002. The 20-month-old twins were joined at the head and underwent separation surgery on Aug. 6, 2002 at UCLA. They were scheduled to leave in late October of last year, but minor complications delayed their departure.

Craniopagus twins – those joined at the head – make up only 2 percent of conjoined twins. Their separation is one of the most dangerous of all operations.

Doctors have performed cranial separations only five times in the past 10 years, and not all twins have survived. This was the first time the procedure had been attempted at UCLA.