Checking on the Injured and Missing

WARNING: POTENTIALLY UPSETTING IMAGES AHEAD.

Nzeli walks on her injured left foot but not her right, one week after receiving antibiotics.

After I darted Nzeli with antibiotics we kept a close eye out for recurrent swelling or discharge from her wounds. The long-acting penicillin we use for darting is formulated to remain in the body's tissues for several days. We often repeat the treatment three to five days later to ensure we've knocked out any bad bacteria.

We dislike using antibiotics unless they're absolutely necessary. Nzeli improved so dramatically after that first dose — which also upset her intestinal flora enough to give her diarrhea — that we decided not to treat her again.

I checked on Nzeli again this past weekend, two weeks after the penicillin dart. She was with Bwenge and the rest of his group on the side of Karisimbi volcano at about 3,200 meters (10,499 feet), surrounded by dense vegetation full of berries and brambles.

Scraping our way through sharp thorns, the trackers and I followed Nzeli as she foraged. She was moving quickly, as evidenced by the scrapes on my forehead (I'd forgotten my hat), and I saw her use her right foot gingerly a few times. When she took a rest, the wounds looked clean. If she has a broken bone in that right foot, it appears to be healing, too.

Karisoke Research Center tracker Faustin Barabwiriza helps examine the carcass of a dead gorilla.

When I had first seen Nzeli injured and not moving, I worried she might disappear later. I've had a few patients vanish since I've been here —gorillas we knew weren't feeling 100 percent, others who disappeared for no reason we could discern.

It didn't help that I'd been called to examine the carcass of a dead female gorilla a few weeks earlier. With one of the Karisoke Research Center's most experienced trackers, Faustin Barabwiriza, I went to examine the body to see if we could learn anything about why she died and to identify her, if possible.

The decomposed carcass of a female mountain gorilla in Rwanda.
This is a nasty looking photo, but it shows an important part of life and work here.

We turned the body over and found very little left to examine. I asked Barabwiriza if he thought it was Papoose, a 40-plus-year-old gorilla from the Titus research group who hadn't been seen in weeks. He nodded yes.

Using a stick, he stretched the skin over the gorilla's skull to re-create her nose print, as if that would convince me! But I didn't think her teeth looked old enough. She could be an unhabituated wild gorilla or maybe a female from Pablo group, Gitebe, who disappeared months ago after we treated her for a presumptive uterine infection.

We may never establish identity in this case, but I did collect some tissue for DNA testing. Karisoke Research Center has Papoose in their genetic database, so we may be able to rule her out . . . or in.

Grauer's gorilla orphan Mapendo with a gradually resolving case of ringworm

Jacques presented Mapendo's case at rounds last week. The orphaned Grauer's gorilla continues to eat well and gain weight, but she remains very timid — and solitary as we've had to quarantine her. Unfortunately, this situation will not change any time soon.

First, she has ringworm. Second, we're not certain where to move her. At rounds we compared photographs of Mapendo's skin condition now to four weeks ago when she was first confiscated [see Two New Orphans]. Overall, she has responded well to topical treatment. But these infections take time to resolve. We’ll need to keep her in quarantine until the fungus disappears completely.

Gorilla doctors get a lesson on emergency medicine from ER doctor, Dr. Denise Baskind.

I'm still amazed that Eddy managed initially to revive Mapendo's companion Vumilia after the sickly gorilla collapsed in the middle of the night. Though it will be months before we have final results on why the animal went down a second time and died, Vumilia's case prompted me to set up a review of emergency medicine procedures.

This month proved to be perfect timing for that project, as we have a volunteer ER doctor visiting from Texas — Dr. Denise Baskind. Denise came to help review our employee health program. Little did she know she'd be helping us practice how to do CPR on a gorilla!

Newly hired ORTPN Akagera Park (Rwanda) vet Noel Arinteireho learns how to
place an intraosseous catheter from ER doctor, Denise Baskind.

Dr. Denise is a fine and experienced teacher — she routinely instructs ER nurses. Magda and I have been soaking up as much knowledge as everyone else during rounds. We've just finished a streamlined and up-to-date protocol for emergency procedures, drugs and dosages.

Also, we have a new tool in our medical field kit: a special drill and attachments for inserting an IO (intraosseous, meaning "into bone") catheter. Denise realized from talking with us that we sometimes have difficulty securing a "line" to our patients, so she called a friend at a medical company (http://www.vidacare.com) who sent us the necessary equipment, along with a plastic bone to practice on.

Female mountain gorilla, Icyi, suffering from exposure, needed an
IV line for fluid therapy while under anesthesia.

Getting a line into a patient can be life-saving. Via fluids and emergency drugs, it's what allows us to support circulation, the "C" of the ABCs of CPR ("A" airway, "B" breathing). A fluid line is standard procedure for anesthesia, too. Unfortunately, the anesthetic combination we use for the mountain gorillas causes veins to constrict, and given the cold and rainy conditions in which we usually work, getting an IV catheter in can be difficult, even for those of us with years of experience. It also takes time. Now, we can get IO access quickly. I think this technique will be a huge help to all of us and our patients.

Ntobo's infant acts healthy, despite strands of hair constricting his fingers on both hands.

Unfortunately, our newest potential patient may be too tiny even for the smallest IO catheter. He's just 6 weeks old, the baby of Ntobo, another female in Bwenge group. This infant has multiple strands of hair encircling several fingers on both hands, partially cutting off circulation and making them swell. He's active and playful and appears normal otherwise. He may be creating the problem by twirling his mother's hair in his hands while he nurses. It doesn't help that Ntobo seems to have particularly long hair.

The problem is not life-threatening for this baby now, so we won't intervene, but it could become a larger issue. If the tissue becomes infected, he could sicken and die quickly. If his hands become too painful, he may not be able to hold onto his mother to nurse.

The best outcome is that the hair will break down soon, ideally with Ntobo helping to clear it away. It's also possible that the constriction from the hair will act like a snare, causing the eventual loss of the ends of his fingers — something we know he can live with as long as infection does not set in. We'll be up and down the mountain checking on him this week.

[Rwanda, Feb. 18, 2008. Pictures: Dr. Lucy Spelman/MGVP]

Comments

[Brenda Watts]

These animals are adorable and it is too bad they have to suffer pain. I am very glad that their is people that are helping them.

[Julie Stuckey]

I am so grateful that you are there helping the gorillas. Thank you!

[haya zommer]

i'm an archaeology student at tel aviv university in israel. i just finished my thesis work on my m.a. degree: tool use by apes, gorilla, bonobo, chimpanzees and orangutan. i'm very interested in doing my p.h.d on gorillas behviour and i would love to get information about joining a research group.

What is your phone number