Quest: Mountain Gorillas: Discovery Channel

What Is Normal?

Bukima's two-year-old infant, Ihumure, in Titus Group.

What is normal? I asked myself that question a dozen times last week in connection with the Goma orphans and their continuing intestinal upsets. What is normal fecal flora for a seven- to nine-month-old mountain gorilla? What should a fecal gram stain look like in a healthy infant of this species? At what age does this change to the pattern found in adult mountain gorillas?

Jean Paul has run this test on free-ranging adult mountain gorillas and on the orphaned gorillas living at Kinigi; he also has experience evaluating the results in humans. But what about mountain gorillas less than a year old?

In Susa Group, Ruvumu's infant seems particularly independent and playful.

Obviously, the most direct way to find the answer to these questions is to collect samples from the field. The problem is that the mother usually consumes the feces of her infant right away, essentially as it comes out.

Two weeks ago, we put out a request for infant gorilla fecal samples to the trackers in Rwanda. Nothing so far. During routine health checks last week, I observed several infants with their mothers, but none produced a sample that I could see, let alone collect.

Kanama's infant in Shinda Group suffered from a bout of diarrhea that resolved on its own.

We've tested one fecal sample from a free-ranging mountain gorilla infant during the past year — a baby with diarrhea. The infant of Kanama (Shinda Group, Rwanda) produced bright yellow, loose stools for several days in enough quantity that trackers were able to retrieve a small sample from the ground.

Our gram stain showed a huge amount of yeast, probably candida, a problem known to occur in human babies and not considered life-threatening if the baby's immune system is strong. If needed, the treatment of choice is daily doses of oral medicine — impossible in our setting. Fortunately, the infant gorilla recovered completely.

Ituza's 18-month-old infant, Umurage, in Amahoro Group.

Another way to confirm a test result as normal or abnormal is to check the reference literature. We often search far and wide for such information — in books, journals and on the Web. But even if we find published normal values for physiologic data in a given species, these must be interpreted carefully. Small sample sizes are the rule rather than the exception in zoo and wildlife medicine.

Without a huge data base, it's impossible to distinguish the slightly abnormal from normal variations. For this particular question, our searches revealed little information on fecal flora results in any great ape, and none at all for infant mountain gorillas.

Ndakasi, now approximately eight months old, in Goma.

A last resort, and one that works pretty well, is to extrapolate from reference information and first-hand experience with better known species — in this case, humans. Jean Paul has worked as a lab technician in human hospitals, and when he compares the results of fecal gram stains in people to gorillas, they are similar.

Above one year of age, people and mountain gorillas have mostly gram-negative bacteria with very little yeast. In human infants less than a year old, there is a mixture of flora. In infant mountain gorillas . . . well, he's just beginning to figure this out with the Goma orphans as his research subjects.

Andre, veterinary technician and gorilla caretaker, sits with Ndeze (lap) and Ndakasi.

These questions were brewing in our minds as we continued with routine staining of the orphan fecal samples in Goma. A few days after beginning the acidophilus tablets, Ndakasi's samples showed a significant change on the gram stain from few bacteria to many of both stain types (positive and negative), including many yeast. We saw less change in Ndeze's sample, but figured it might just take her a few more days for the friendly flora to build up.

I talked again to docotors Caleb and Louis King at nearby Shyira Hill Hospital; they confirmed that a mixture of bacteria is normal in young human infants and said they never treat for the yeast.

Ndeze, a little weak from intestinal upset.

Then Ndeze surprised us and fell ill with diarrhea for the first time. Her milk intake dropped by half, though she continued to play. Her gram stain didn't look all that different from before, so we agreed to wait and see if her system could handle a bad bug — maybe she was just now showing signs of exposure to the same bacteria that had given Ndakasi a problem. If the acidophilus was working, we hoped she wouldn't need treatment.

We did consider that the acidophilus itself might be the problem, but that didn't really make sense. Had the orphans been in Rwanda, Jean Paul could have set up fecal cultures to be sure. But once again, the infants' location in DRC limits our ability to do proper diagnostics.

Ndeze, much improved after a day on antibiotics.

The next day, Ndeze showed no improvement and had lost weight, a sign of dehydration. She continued to play, but with less vigor. Reluctantly, we began her on a course of broad spectrum antibiotics, the same one we'd recently chosen for Ndakasi.

Ideally we'd wait and culture the fecal sample first before choosing an antibiotic in order to grow the bug to identify it. But these infants have so few physical reserves that waiting for a definitive result could be disastrous. In any case, we have limited capabilities for antibiotic sensitivity testing even at the MGVP lab in Rwanda.

Like Ndakasi a few weeks ago, Ndeze was much brighter after just one dose of antibiotics. This rapid recovery is much faster than we'd expect if they were suffering from a serious bacterial pathogen or a viral diarrhea. These results support our working diagnosis that their intestinal problems are not due to any particular bacteria but rather to opportunistic ones that can readily dominate their less-than-normal intestinal flora.

We worry that repeated antibiotic therapy will have the same effect, by wiping out the good bacteria too. Acidophilus tablets are used for this very purpose, so the next few days will be another good test of how well this supplement works in mountain gorillas.

Ndakasi takes her mid-morning bottle from gorilla caretaker Richard.

After a week on acidophilus tablets, Ndakasi looked great — bright, strong and active. For the first time, her 24-hour milk intake hit one liter and her weight tipped the scale at 6 kilograms. Now the question is, will the bouts of diarrhea stop?

In theory, if we've helped the orphans establish a more "normal" intestinal flora, they should have more consistent stool. Their feces may never have the same color and consistency as that of a free-ranging infant mountain gorilla, but we may find that the gram stain results are similar. This result could be as close to establishing a norm as we can get — for now.

[Rwanda, Dec. 17, 2007. Pictures: Lucy Spelman/MGVP]

The Congo War and Ebola Virus

A view of Lake Kivu just north of Goma, DRC, which is the site of recent rebel fighting.

Last week, the Congolese government launched attacks on the rebels hiding out near Goma and the DRC side of the Virungas park. Lawlessness in this region led earlier to the outright killing of at least a dozen mountain gorillas (Gorilla Slaughter, A Personal Account).

Now, people displaced by the war are taking what they need from the forest — cutting down trees to make charcoal for fuel, searching for freshwater and hunting in order to survive. Refugee camps are also multiplying, increasing the risk of the spread of infectious diseases to the gorillas.

I hope Anderson Cooper's story, which aired recently on CBS' 60 Minutes, draws attention to the fact that this war threatens the health of the entire DRC Virungas ecosystem: the people, the gorillas and the forest.

Mountain gorilla orphans Ndeze and Ndakasi play on their wooden tripod in Goma, DRC.

The deteriorating situation around Goma also threatens Ndakasi and Ndeze, the two orphaned mountain gorillas still being cared for there. We continue to wait for permission to move them to Kinigi, where I think they would thrive.

I wrote in an earlier blog that we'd begun feeding them yogurt as a treatment for the diarrhea that has afflicted them off and on to help promote friendly intestinal flora, bacteria they would normally acquire from their mother's milk. Unfortunately, they didn't really like the yogurt, so we've switched instead to acidophilus tablets in their milk. Now, Jean Paul is running special stains on their feces so we can monitor the changes, if any. I've asked him to teach the field vets how to do this test. The orphans continue to present a learning opportunity for all of us at MGVP.

The border between the Bwindi forest in Uganda and cultivated land.

Meanwhile, an outbreak of Ebola virus has killed two dozen people in Uganda. It began in a town a considerable distance from our area, but the contagion is still closer to Bwindi and the Virungas park — and Rwanda — than it's ever been before. This rapidly fatal hemorrhagic fever spreads through close contact with infected body fluids. Infection in humans has been linked to the practice of eating bush meat, particularly primates and fruit bats.

This virus has also killed thousands of lowland gorillas and chimpanzees elsewhere in Central Africa. Though it has never been reported in mountain gorillas, we consider them highly susceptible. The disease is so nasty that relatively few — people or animals — survive the infection long enough to infect others, so Ebola rarely spreads great distances. Even so, we're all on alert as the situation progresses.

An infant mountain gorilla — Umoja — in Kwitonda Group, Rwanda.

Despite the November and December rains, we have not yet had a case of respiratory illness among the mountain gorillas in Rwanda and the mild coughs in Uganda's Nkuringo Group have resolved. We don't know, of course, about the gorillas in DRC. All we can do is carry on with our jobs in the places where we can safely monitor the gorillas.

When I made a routine health check to assess the members of the Kwitonda Group this week, their pristine forest home seemed light years away from the war and the deadly Ebola, but it's not.

Infant Segasira in Kuryama Group, Rwanda.

During my first month on the job in last year's rainy season there was a severe outbreak of flu-like respiratory disease in Rwanda's Pablo Group that led to the death of several infants. Just as the group began to recover, poachers at the Rwanda-Congo border splintered the family, separating infants from mothers and leading to the death of those who were too young to survive the sudden weaning.

Every time I see the lone survivor, Agahozo, united again with his mother in Pablo Group, I think of the need to prevent these incursions from the outside — poaching and the introduction of human disease.

I responded to a call about a coughing gorilla last week, fearing this could be the start of a new outbreak. The trackers had reported a persistent cough the day before in 2-1/2-year-old Segasira, an infant male in the Kuryama (research) Group.

He wasn't coughing during my visit, however, and appeared perfectly normal. He'd probably had what we call a "gallium" cough. This sticky plant often catches in the back of a gorilla's throat, causing irritation that produces coughing. Because we know that coughs and sneezes can be intermittent, it's always a good idea to stay in the group for at least an hour to be certain there’s no problem. So I took plenty of time to watch Segasira playing, eating and tumbling with the other youngsters in order to make sure he was OK — the best part of the job.

Magayane has recovered completely from the loss of the end of one finger from a poacher's snare.

A group of us met at MGVP's offices in Ruhengeri recently to review what we know about Ebola and to discuss the increasing number of refugee camps nearby in DRC to be certain we're all sharing information as it comes in. The meeting was also an opportunity to go over all of the guidelines in place to protect the health of the mountain gorillas from tourists, scientists, park staff and the military.

We agreed the Ebola outbreak in Uganda is not so close that we recommend immediate action like closing border crossings or access to the park. But everything could change rapidly if the infection should spread in our direction.

Two years ago, the silverback mountain gorilla named Kwitonda moved
his family to Rwanda from DRC, and he hasn't gone back.

For general information on Ebola, check the Centers for Disease Control.

Sciencedaily is very readable and gives many links about this disease.

For news updates on Ebola as well as the DRC Congo War, check Reuters.

See also various blogs on Wildlife Direct for more about the Virungas park in DRC.

[Rwanda, Dec. 9, 2007. Pictures: Lucy Spelman/MGVP]

Orphans and Wild Gorillas in the DRC

Seven-month-old Ndakasi in Goma, DRC.

After Ndakasi recovered from her last bout of diarrhea, we built the orphans a climbing frame out of eucalyptus. It doesn't look like anything in the forest, but it works. Both infants took to the teepee-like structure immediately.

Last week, I watched Ndakasi hang from one arm and twirl about, reaching with her other arm to grasp a stalk of wild celery the caretakers had draped over a crossbeam. It was a striking change from her condition the day before, when she'd been ill again with liquid, watery stool — the reason for my visit.

Ndakasi eats wild celery.

When Ndakasi's diarrhea recurred this time, we ran a series of fecal tests — all negative for parasites and pathogenic bacteria. As before, we tried antibiotics and saw immediate improvement. Such a rapid response suggests that her problem is lack of intestinal flora rather than a specific infection.

In this case, the antibiotics work by controlling an overgrowth of bacteria. Had Ndakasi grown up in the forest, she would have been exposed to mountain gorilla microbes on a daily basis, enough to populate her gut. Instead, she drinks sterile milk formula and lives in a relatively clean environment.

Ndeze suffers from the opposite problem: constipation, so much so on some days that she loses her appetite. Because artificial milk formula can be dehydrating, the caretakers routinely offer the infants a bottle of oral rehydration solution between bottle feedings. But Ndeze doesn't like plain or even flavored fluids. Recently, we decided to dilute her formula and add one more feeding. This strategy seems to help. But perhaps she, too, would benefit from more intestinal flora.

Dr. Eddy Kambale, MGVP field vet, performs a daily exam on the mountain gorilla orphans.

As luck would have it, a family acquaintance of mine, Dr. Caleb King, tracked me down a few days ago. I had no idea that he and his wife — both physicians — run a hospital in Rwanda (Shyira Hill Hospital, http://www.shyira.org/visitors.htm) or that he was a Harvard-trained pediatric gastroenterologist. Now the orphans have another expert on their side!

He agreed that the best medicine for both could be something very simple: yogurt, preferably apple-flavored. Apples contain a type of carbohydrate — pectin — that helps stabilize the intestinal tract, and yogurt contains gut-friendly bacteria.

Ndeze needs more space and repeatedly climbs the vine around the guava tree in the Goma house garden.

Watching the orphans in Goma, I found myself distracted by the sounds of radios blaring and children crying. The house, surrounded by a walled garden, sits on a busy street in this town of several hundred thousand people, and is far from ideal for a pair of infant mountain gorillas, the first ever to be hand-raised from such a young age. The climate isn't right, and armed rebels continue to fight the government army on the outskirts of town.

MGVP has already recommended that Ndeze and Ndakasi be moved to the quarantine facility in Rwanda, at least temporarily, to join the other eight DRC orphans. We hope the chain of paperwork goes through soon.

Both Ndeze and Ndakasi show great interest in the yogurt offered by Dr. Eddy Kambale.

It was time to try the yogurt. Ndakasi tasted it only after Ndeze had taken a spoonful. They seemed to like it, but we won't know for several days how much of it they'll eat and how effective it will be. If the yogurt works to reduce intestinal upset, it also could have an effect on stool color by stimulating more digestion and thus releasing bile acids, the chemicals that color the feces brown. That would be an added benefit as both orphans have very light-colored stool, which is not normal, even with the addition of forest food to their diet. For now, we'll have to wait and see.

Chimanuka, silverback of the Chimanuka Group of Grauer's gorillas,
in Kahuzi Biega National Park, DRC.

The next day, I traveled farther into the DRC to make my first visit to the habituated eastern plains, or Grauer's, gorillas in Kahuzi-Biega National Park. MGVP has been monitoring the health of these rare gorillas for over a year, an effort we plan to continue.

Although there are thousands of Grauer's left in the DRC, the only place they are found worldwide, their numbers are rapidly declining due to poaching and habitat loss. Less than 200 live in this particular park, which is set up for tourism. A big difficulty is getting there safely.

A female Grauer's gorilla in Kahuzi Biega National Park.

Though it's possible to travel by boat along Lake Kivu to the city of Bukavu near Kahuzi Biega Park, the vets need a truck to get in and out of the park itself. So we drove there from Goma, about 190 kilometers on a rough road.

At one point, we had to pay a man driving a motorcycle taxi to pick up a battery that could jump-start a truck blocking our way. Then our car broke down in a remote area — at night. Fortunately, a dozen people stopped to help us fix it (six U.N. trucks drove right by!). But our encounter with the gorillas the next day made the 10-hour drive more than worthwhile.

A sub-adult Grauer's, or plains, gorilla in Kahuzi Biega National Park.

In sharp contrast to the sometimes dusty, sometimes muddy terrain over which we'd traveled, the forest of Kahuzi Biega National Park felt peaceful and remote. The gorillas crunched their bamboo while a few of us watched quietly.

Grauer's gorillas are larger than mountain gorillas, with longer forearms, a flatter face with less hair around their eyebrows and wrinkles instead of distinct nose prints. Since they live amid dense vegetation, identifying individuals of this subspecies can be a major challenge.

Freshly logged forest, probably for charcoal production, near Kahuzi Biega National Park.

I spent the next day traveling near the park as part of a six-person team searching for a possible sanctuary site for the Grauer's orphans in Rwanda so that they can go back to their homeland. Our goal was to find a patch of forest that could work as a future semi-wild home for Itebero, Dunia, Tumaini, Ntabwoba, Pinga and Serufuli.

With continued logging and mining in the area, this subspecies faces a future far bleaker than that of the mountain gorilla, unless park rules are enforced and tourism can be increased to pay for their protection.

A forest patch in the middle of a tea plantation: a future sanctuary site?

Our selection criteria include security, lack of poaching, proximity to Kahuzi Biega Park, an accessible road, and any kind of natural boundary that would help keep gorillas in and people out (in addition to a fence).

After viewing several sites that did not meet these specifications, we checked out a patch of forest in the middle of a tea plantation. Had this been a banana plantation, we'd have dismissed it on sight. But as far as we know, gorillas don't go for tea leaves. We left feeling positive that we'd found a possible site for a DRC Grauer's gorilla sanctuary, if all goes well. But that's a big if.

[Rwanda, Dec. 2, 2007. Pictures: Lucy Spelman/MGVP]