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]

Comments

[Sheryl]

Dr. Spelman, what a surprise! I've been following Paulin Ngobobo's blog at wildlifedirect.com for months and lately the news hasn't been very good. I knew that Ndakasi was at the MGVP hospital in Goma and I learned today that another orphan, Ndeze, is there, too. I visited the MGVP Web site and found this blog and I'm so pleased to hear that Ndakasi is doing well. Please update about Ndeze soon - there are a lot of people worried about her.

BTW, I'm an Asia Trail volunteer at the NZP. A couple of weeks ago we were taken on a behind-the-scenes tour of the sloth bear and small-clawed otter exhibits. Very exciting! Your project is doing well. :-)

[Lauren]

I also came here by way of Paulin Ngobobo's blog at wildlifedirect.org, where he passed along the news of Ndeze today. A lot of folks around the world are thinking about these mountain gorillas! What terrific work you all are doing. Your blog and photos are great, too. Wish I could come and see it all first hand.