Quest: Mountain Gorillas: Discovery Channel

Ndakasi: Small, but Strong

This week, Ndakasi was on my list for a follow-up health check. All reports were that the orphaned mountain gorilla had been doing well, taking a full bottle at each feeding and steadily gaining weight. According to Eddy, her primary vet, she'd even begun to resist her daily physical exams — a great sign that she was getting stronger.

It was hard for me to imagine her as a feisty little gorilla. The first time I met her she was very ill and weak. The second time, she was just barely able to take her bottle and needed oxygen around the clock.

I was excited during my drive to Goma and looking forward to seeing Ndakasi feeling well rather than at death's door. We'd set up an intensive-care-style schedule of health checks and Eddy had been sending us the results of her physical exams. But those were reports on paper. Today was my chance to see her recovery for myself and there were a few things I wanted to check carefully.

My main goal was to get a follow-up blood sample. It had been three-and-a-half weeks since we first diagnosed Ndakasi's pneumonia. I'd gotten a tiny amount of blood then and saved it; by taking a second sample now, I'd have what we'd need to run paired titers. This special set of lab tests might ultimately reveal which virus or other microorganism had caused the baby's illness.

She had been anemic last time I visited and I hoped we'd see her red blood cell numbers go up today. I also had concerns about her body weight -- at about nine pounds, she's small for a four-month-old mountain gorilla. She had been drinking full-strength formula for only a week before she became ill, and was underweight even then. It takes a lot of calories for a healthy infant, let alone a sick one, to maintain its body temperature, and her metabolic rate had probably doubled during the illness. This is one baby who can't afford to get sick again any time soon.

The weather made me worry about Ndakasi's hydration. It's very dry in Goma — the town is at a lower altitude than the Virungas —and now it's the dry season. Instead of a wet and misty drive, my trip to the Rwanda/DRC border was dusty. The difference was striking, almost as if I'd gone to a different country. My hair is always a good measure of humidity. Curly in the wet season, it's now almost straight. Instead of slightly frizzy, moderately short hair, I have long straight hair that keeps falling in my face.

Infants lose body fluids as easily as they burn calories. The humidified air produced by the oxygenator machine and the nebulizer definitely helped Ndakasi stay hydrated. But she wouldn't tolerate the treatment anymore. She'd learned quickly how to push the hosing away from her face with her tiny hands, diverting the moist vapor. Now that we'd gotten her through the illness, my sense was that her entire system would be better off in a natural environment. I thought I'd suggest to Eddy that he attempt the homemade eucalyptus leaf humidifier therapy only once in a while.

Lastly, I wanted to be certain that the variable blood oxygen level readings Eddy was recording were due to the baby's movements (the sensor doesn't work well with any type of motion) and not residual problems with her lungs.

Eddy had reported that Ndakasi wouldn't hold still for anything these days. It was taking him as long as 30 minutes just to complete a single "TPR" (temperature, pulse and respiration) without stressing her. When the gorilla was weak, she allowed Eddy to do these brief exams in just a few minutes. He could wrap the pulse oximeter sensor around her thumb and she’d ignore it; now she pulled it right off.

I hardly recognized Ndakasi when I walked into the room. She was bright-eyed and she'd grown noticeably since my last visit. I think Andres (one of her caretakers) could tell I was smiling, though my mask hid most of my face. Like all baby animals, she gazed back at me with an endearing expression.

The calm didn't last long, however. Ndakasi wanted nothing to do with my stethoscope or the oximeter — just as Eddy had reported. When it was time for the blood sample, she let me know exactly how well she was feeling: she squeaked, chirped, struggled and even tried to bite Andres! She was such a strong, moving target that it took me three sticks to get the complete sample.

She recovered quickly once back in Andres' arms, though she may very well remember me next time as the not-very-nice white ape with the needle.

Back in the lab, we found that her anemia had resolved. Now we just needed to get permits from the various governments to send mountain gorilla blood samples out for analysis. That's a whole separate project, but it could add valuable information to what we know about respiratory illnesses in mountain gorillas. At least we can take Ndakasi off the active patient list.

Sadly, I've just learned that there's been a tragic incident in the DRC like the one that orphaned Ndakasi. Wild mountain gorillas have again been shot to death and at least one infant left motherless — Ndakasi now has company.

To be continued. . .

[Rwanda, July 16, 2007. Pictures: Lucy Spelman/MGVP]

Mission Giraffe

[Click on the pictures to see larger versions with captions.]

I came to live in Central Africa because of the wild mountain gorillas. But they aren't the only animals that need health care around here.

When it comes to wildlife medicine, we (MGVP) are the major resource in Rwanda and the adjacent areas of Uganda and the DRC. There are district veterinarians who take care of farm animals, a handful of small-animal veterinarians who work in the cities and a few government-salaried vets, but overall, we're the only professionals in the region whose job it is to look after sick or injured wild animals. So we do what can when we're not in the field with the gorillas.

In the past six months, we've treated or collected samples from a variety of species: a chimp with meningitis, a baboon with a snare injury, two golden monkeys caught by farmers for stealing potatoes, a half-dozen parrots, numerous wild forest buffalo (several of which were killed by the local community for meat), and several dozen dogs whose owners requested a spay or neuter. I even paid a call to check on a downed cow belonging to the chief park warden of the Parc Nationaux des Volcans in Rwanda. Just as I was deciding she must be suffering from low calcium or magnesium, the district vet appeared and administered the treatment for both problems. She was up in an hour.

So when my cell phone rang the other day about a new non-gorilla problem, I took a deep breath. Luckily, we had no active wild gorilla patients because this case was going to be a big one — a giraffe with a snare around its leg in Rwanda's southernmost park, Akagera, a four-hour drive from here.

The park system vet, Dr. Tony Mudakikwa, was calling to ask if I had a particular type of anesthetic and if so, could he get a supply from me? My answer was no, but I had something similar. I wanted to help, but reminded him — and myself — that giraffe anesthesia is very risky and should be attempted only if absolutely necessary. I'd have to call or e-mail for advice from my zoo and wildlife vet friends about the dosage. Meanwhile, could he find out more about the giraffe, or maybe even go see it?

I'd anesthetized several giraffes in a zoo setting years earlier and knew how difficult it was to do this procedure safely — for the people and the animal. But I also felt we should try if the problem was confirmed and there were no other options, like flying in experts from South Africa who do this sort of thing routinely. I called each of our field vets and our director, Mike. All agreed: we should help and we’d work together as a team.

The subject line in my e-mail query read, "It's a giraffe with a snare, not a gorilla!" I figured they might wonder why I was asking them about giraffe anesthesia when they know I work in the mountains and not the savanna. The word "snare" would explain. This is an awful injury no matter what the species — all the more distressing to a vet because it's caused by human hunters.

Two days later, armed with expert advice and all of the equipment we could think of to bring, our entire MGVP field vet team gathered in Ruhengeri at 4 a.m. — myself, David, Jacques and Eddy from the DRC, Benard from Uganda and Jean Felix from Rwanda. We picked up Tony, the park system vet, in Kigali — he hadn't yet managed to get to the park to see the patient — and arrived at Akagera National Park by 7:45 a.m.

Akagera's warden, Robert, and one of the lead rangers, Roger, were happy to see us. They explained that the giraffe, a nearly full-grown male, had become unable to keep up with the herd. Worse, he was so lame that he was barely eating and hadn't found his way down to the watering hole in days. We set off to take a look at him, driving into the park and then following him on foot. Tony felt this would be best, though I'd never gotten close to any hoofed animal without remaining hidden in a vehicle. We scrambled through the thorny acacia, but could get no more than a distant glimpse of our patient.

We switched back to the truck. An hour later, after driving slowly through the bush with the thorns screeching against the metal sides of the car, we finally got a good look at the giraffe and were able to take pictures. The young bull had a dark wound encircling his lower left front leg above the hoof and the entire leg was swollen to twice its normal size.

He also looked thin. The problem was not new, we learned; nor were we sure we were seeing a snare. If we decided to try anesthesia, the difficulties would be even greater than I'd envisioned. Darting alone would be a challenge, since this was not open savanna. I urged Tony to call the South African experts. Two hours later we heard that they couldn't get to Rwanda any time soon.

I thought to myself, "Do I do this?" It's true that I'm the only one in all of Rwanda who knows how to anesthetize a giraffe; on the other hand, since I've never worked on a wild giraffe, some of the experience will be new to me, too. The recommended anesthesia involves a three-drug combination that has only been recently studied in this species. Plus, these anesthetics are dangerous to handle and our team members will be speaking different languages — English, French and Kinyarwanda. But if we don't act, the giraffe will continue to suffer — veterinarians take an oath to help animals in need.

I decided the right thing to do was try. But by then, the day was mostly gone; we'd have to stay the night and make the attempt first thing in the morning.

Despite a night of little sleep, my mind occupied with all the things that could go wrong with giraffe anesthesia, I felt calm the next morning. We drove slowly through the thick bush up to the lame giraffe. I'd decided to give the anesthetic all in one large volume dart, which meant using a CO2-powered pistol (our powerful and more accurate rifle takes only small darts). This meant we had to get close.

The giraffe was calm but kept his distance. I had to aim high and lob the dart in. It stuck, but not hard enough to inject. I made another dart and lobbed it in. It went off just fine. The giraffe went down smoothly 14 minutes later. He lay on his side and breathed well.

We'd assigned everyone a duty and those working on anesthesia with me, including Eddy and Benard, helped to get his head and neck properly positioned — outstretched on a board.

The snare-removal team started in on their job. They confirmed what our pictures had told us: there was no longer a snare embedded in the leg. Jean Felix, Elisabeth, David and Tony worked rapidly to cut away the ring of scar tissue and clean the wound, following the track down to the bone.

I briefly examined the leg with them. We couldn't find any foreign material, but hoped that by cutting away the old diseased tissue and aggressively cleaning the wound we could reduce the tremendous swelling. Meanwhile, Benard got blood samples and Jacques snapped pictures.

I focused nearly all of my attention on the giraffe's breathing, determined that he survive the anesthesia (even in a zoo setting, one out of three giraffes do not survive). When his breathing rate dropped, I asked everyone to finish quickly so that we could wake up the animal. Jean Felix gave our patient a huge injection of penicillin, many times the volume of antibiotic needed for even the largest gorilla.

As soon as I gave the anesthetic reversal, I knew we'd be OK. The giraffe had gone down well and we'd worked quickly — the actual procedure had taken just 30 minutes. Now we needed to wait with him patiently and not encourage him to get up too quickly. I could see my team was a bit anxious, not knowing what to expect. We’d gathered around the backside of the giraffe, gently holding his shoulder, neck and head down on the board.

Sure enough, he began to blink and flap his ears under the blindfold after 10 minutes. I waited another five and pulled off the towel, but kept my hands under his jaw and asked everyone to back away. With a little push upward, the giraffe lifted his great head and neck off out of our arms, rolled back on his sternum and put his front knees down on the ground. He rocked back, pulling his rear legs under his body, then lifted his upper body and flipped his front legs under him. He stood up on all fours just seconds later and then walked quickly away from us.

I slapped Tony on the shoulder. "Yessss!! We did it!" Everyone was all smiles. David jumped up on the roof of the truck to keep an eye on the giraffe while everyone else packed up the gear. "He's walking slowly. Can't see him now behind the bush. There he is, still moving, looks normal, neck looks fine, perfectly straight. Gone now. There he is again. Seems fine."

The next day the giraffe was seen eating, though still limping and alone. Two days later he was back with his herd. Five days later the lameness had all but resolved. The combination of antibiotics and wound treatment seemed to have done the job. I suppose there could have been tiny fibers of an old rope snare embedded in that scar tissue, though the rangers say people use only metal snares around the park. Though we may never know exactly what caused the giraffe’s injury, we do know our teamwork probably saved his life. That's a good feeling.

[Rwanda, July 10, 2007. Pictures: Lucy Spelman/MGVP]

What's in a Name?

Nyiramurema's infant a month before the naming ceremony.

The last time I paid a visit to the Kwitonda group it was to check on Nyiramurema's infant. The trackers had seen a white discharge from his left ear, possibly an ear infection. This little one had been through a lot, including an awful week when most of the gorillas in his group were coughing, one baby died and his mother lagged behind. After watching him climb around in the bamboo for a half-hour, I finally got a good view of his left ear: no problem.

Then, a few weeks after my visit, I was given the honor of naming the young gorilla at Rwanda's annual ceremony, called Kwita Izina.

Drummers perform at Kwita Izina, the gorilla naming ceremony, Rwanda June 2007.

Just two days before the ceremony, I received a call from Fidèle Ruzigandekwe, the lead administrator for ORTPN (Office of Tourism and National Parks). He asked if I would be willing to represent the conservation partners at Kwita Izina and name one of 23 infant gorillas. (Park officials customarily name the infants just once a year, partly because not all survive their first few months of life.) Stunned, I replied, "Really? Yes, of course — what an honor! Thank you so much!"

Thousands of Rwandans attend the gorilla naming ceremony in Kinigi.

I knew the naming ceremony was a major event, but I had no idea it would begin with two hours of drumming and dancing, or that tens of thousands of people would attend. The idea behind Kwita Izina is to promote the success of mountain gorilla conservation in combination with tourism in Rwanda. By spreading the word nationally and internationally, the leaders of ORTPN seek to raise awareness and funds to support all of Rwanda's national parks.

Dancing at the Kwita Izina ceremony.

Fidèle had explained that the ORTPN staff would suggest three names for each infant and that I'd have some time to think about my choice. I liked all three: Kwagura, which means "to extend" in Kinyarwanda; Furaha, "joy" in Swahili; and Umoja, also a Swahili word, meaning "unity." While the drumming and dancing continued, I wandered around asking people for their opinions, including members of the MGVP staff.

Special entertainment provided for guests invited to name a gorilla at Kwita Izina.

The event was well organized. Rwanda's president, Paul Kagame, arrived and took his seat; later he'd give a speech. The entertainment resumed and those of us naming gorillas were called down to the urugo, or traditional hut, set up near the stage. Half of the group entered the house to be dressed for the ceremony, and a dozen kids dressed in gorilla suits made the rest of us laugh.

Lucy waits with other guests invited to name a gorilla, including Marjorie Kaplan (far left).

As our group waited to be dressed, we introduced ourselves. I enjoyed meeting everyone, particularly Marjorie Kaplan (far left), general manager of Animal Planet. Fifteen minutes later, she and I found ourselves inside the hut in a tiny space partitioned from the men's section. We had to laugh — we'd known of each other for years but had never met, and here we were sharing a dressing room!

Jack Hanna named Bikereri's infant Ingufu, which means "energy/strength."

The week before the ceremony we'd had several special guests at MGVP, including Jack Hanna and Natalie Portman. They too had been granted the honor of naming a gorilla infant. Jack was among the first in line during the ceremony. He chose Ingufu (strength, energy) for Bikereri's infant in Pablo group.

Actress Natalie Portman was a special guest at Kwita Izina.

Natalie looked stunning in her ceremonial dress. Before announcing the name she'd chosen, she told the audience about her trek to see the mountain gorillas the day before. She'd visited Group 13 and said she had fallen in love with the entire family as she watched the youngsters play while their parents ate bamboo shoots.

Actress Natalie Portman named Ahazaza's infant Gukina, which means "play."

Natalie chose the name Gukina, which means "play," for Ahazaza's infant. This is a baby whose face I know well and have photographed several times, because both she and her mother have a mild skin condition. It's certainly not life-threatening, so we haven't done an exam and don't know its cause. We think it's a microorganism that thrives in moisture, one that may be spread by contact with domestic animals.

Nyiramulema's infant a month before the naming ceremony.

Just as it does before I dart a sick gorilla, my heart started pounding when it was my turn to speak. Somehow I managed to stay calm enough to start with the Kinyarwanda I'd practiced: "Marakoze, marakoze. Nyakubahwa, Monsieur President. Banyakubahwa, mwese." (Thank you, thank you. I am honored, Mr. President. I am honored, everyone.)

Nyiramurema's infant again — now named Umoja.

In English, I explained that this was an infant I knew well, because he and his mother had disappeared for a week during a respiratory outbreak in Kwitonda group, prompting the park staff to pull a special team together to track the pair. The ORTPN trackers camped out every night until the gorillas were safely located, then called the vet team to check them. Because we'd all worked together, I chose the name Umoja — "unity" in Swahili.

Jean Claude, one of MGVP's support staff, celebrates Kwita Izina.

Everyone here is used to seeing me in less-than-feminine field clothes suited to long treks in the mud and rain. After the ceremony many people — including our MGVP support staff — came up to me smiling, offering their compliments about how wonderful I looked in the ceremonial dress. I've saved the material and am now ready to dress Rwandan whenever the opportunity arises!

Lucy proudly displays the photograph of the newly named mountain gorilla, Umoja

Finishing my story about Umoja, I added that I'd picked the name for another reason: the future of this fragile species hinges on regional protection. The Kwitonda group of gorillas moved some time ago from the Democratic Republic of Congo to Rwanda. Were they in search of a safer area? Though I didn't say it, Ndakasi — the little orphan whose mother was shot in the DRC — is a constant reminder in my mind that we need to do more together, and soon.

[Rwanda, June 30, 2007. Pictures: Boanna Owens/MGVP | Lucy Spelman/MGVP | ]

One Gorilla Saved

[Click on the pictures to see larger versions with captions.]

Our newest orphan is bouncing back from a severe illness. And now she has a name — Ndakasi (en-dah-KA-si). A week ago, the two-month-old gorilla could barely breathe. It was as if her lungs had shut down.

Our tentative diagnosis was acute viral infection, possibly an influenza virus or one called respiratory syncytial virus. Another possibility was Chlamydia pneumonitis. She was also at risk for developing a bacterial infection. During one very intense morning, we'd rushed to create a mountain gorilla I.C.U., aided by the generosity of two United Nations doctors. (See The Newest Orphan).

Thanks to our improvised oxygen chamber, the baby's blood oxygenation levels increased from critically low to normal later that same day. But she remained dangerously weak, even inside the chamber. It had been two days since her last bottle. Human babies with severe lung infections receive intravenous nutrition. This wasn't an option for a five-pound gorilla in the DRC. I also worried that she might have suffered damage to her internal organs as a result of hypoxemia, a period of low blood oxygen that can harm the kidneys and the brain.

The fact that the gorilla had responded so quickly to oxygen and nebulization therapy was a very good sign. I left Goma thinking she had a chance to live. If her lungs began to recover she should regain enough strength to take her bottle. My best guess was that we'd see a trend within 12 hours.

We agreed that Dr. Eddy would remain with Ndakasi at all times along with her caretakers, Andres and Alfonse. I would return to Rwanda for the next day or so to analyze her lab results and gather more supplies. David and Simon would stay in Goma at first, and then we'd switch.

Thirty-six hours later I returned to the DRC. This time I was all smiles at the border crossing. In broken French, I explained to the customs officials that the baby gorilla was better. She'd taken her first bottle at 3 a.m. the night before and had continued to drink small amounts of milk throughout the day. When I'd made the crossing earlier in the week, the officials had laughed incredulously at the idea of treating a baby gorilla. But now they were curious about her. They nodded and smiled back at the good news.

When I arrived at the house in Goma I found Eddy looking tired but relieved. The baby's weight was stable and her milk intake had continued to increase slightly at each feeding. Andres was ready to feed her, so I sat down to watch. He carefully positioned Ndakasi in an upright sitting position with her back supported by the side of the chamber. Cradling her head with one hand, he held the bottle for her in the other. She suckled slowly and weakly for a few minutes. Then she closed her eyes and slumped down. Clearly, it was a huge effort for her to drink — but she'd taken almost 40 milliliters.

Next we checked her blood-oxygen saturation level to see if she could hold her own without oxygen. During her 10-minute feeding, the levels had dropped significantly, from the 90 percent range down into the 70s. I listened to her lungs with my stethoscope. As before, I could hear no air moving in the baby's small airways, only in the larger ones. Her heart rate continued steady and strong, if higher than normal. It was clear that although we were keeping her alive with the oxygen, her lungs had not yet recovered. Once back in the chamber, the gorilla's oxygen saturation returned to normal.

I reviewed the treatment plan for that day with Eddy: antibiotic and antifungal medicines, multivitamins and iron (she was anemic) and bottle-feeding every three hours. In the meantime, Ndakasi would remain in the chamber with a nebulizer session every hour. Like human infants with similar lung problems, the gorilla would undoubtedly need several more days of oxygen therapy. I stressed to Eddy that now was the time to be patient. He'd never been in charge of a case like this, so I encouraged him to be vigilant and keep an eye and ear out for even the slightest change. Undoubtedly, he'd be the first to hear normal lung sounds if they resumed.

Despite my advice to Eddy, I hoped to see incremental improvement by the end of that day. Instead, the gorilla refused two feedings in a row. It was hot and stuffy in Goma. Maybe the warm temperature had affected her appetite.

Then the power went off and the oxygen machine with it, forcing Eddy to run out for generator fuel. Once again, I sat by as the baby's condition deteriorated. Though he solved the problem very quickly, my worry level went back up. What if this life-saving oxygen machine broke down? As I drove back to Rwanda, I tried to remember my own advice: give her time. The evening will be much cooler — she'll take the bottle better then.

Not only did she take her bottle later that night, she continued to drink more at each feeding over the next three days. Meanwhile, her respiratory rate gradually decreased from more than 100 breaths per minute to 80 and then 60. Her heart rate came down as well, from over 150 beats per minute to 120 beats per minute. Though her oxygen saturation remained below normal whenever she was outside the chamber, the difference was less and she could hold her own a bit longer.

"She's going to live! Elle sera survivre!" I announced to the customs officials on my next visit. If they could have, I think they would have waived the $30.00 border fee. (In relative terms, Ndakasi was racking up an expensive bill, but so what?) The moment I saw the tiny gorilla, there was no remaining doubt my mind. Eddy himself looked at ease and in charge. The room was clean and organized and he was ready for me. I sat down to watch the 8 a.m. routine.

The oxygen chamber was positioned at the foot of the bed. Andres and Alfonse had taken turns — for days now — sitting or lying down so that the infant could see their faces. Successful hand-rearing hinges on human contact, and as she improved, she began to show signs of agitation if she couldn't see one of them. Normally, gorilla infants are held close to the mother's body and soon learn to cling to her day and night. They are never set down to sleep on the ground, where they can quickly become cold and die of exposure.

When Ndakasi was very ill, Andres in particular was reluctant to set her down. Then, as he saw how much better she looked in the oxygen chamber, he realized that holding her didn't help her — or him. But now, on day seven of oxygen therapy, she was clearly very aware of him and demanding his attention. With one hand in her mouth, she raised the other and reached out for him, her eyes wide open. She was asking for her bottle. Andres picked her up and fed her. This time, she took 60 milliliters of milk with vigor.

I checked her lungs. There were normal sounds in all fields. Eddy had first heard them yesterday. Hooray!

We made minor changes to her treatment plan. Andres and Alfonse could hold Ndakasi whenever she wanted to be held. They'd put her back in the chamber only to sleep. We'd stop all her medicines the next day and continue the oxygen into week two. Eddy would continue to examine her three times a day and sleep at the house just in case something changed. With any luck, she'd be back to normal soon.

So far our luck — and Ndakasi's — is holding.

[Rwanda, June 28, 2007. Pictures: Lucy Spelman/MGVP]