Quest: Mountain Gorillas: Discovery Channel

Check and Check Again

Two mother gorillas with their infants from Group 13 scale a steep slope on Sabinyo volcano, Rwanda.

During a routine health check to Group 13 in Rwanda last week, I focused my attention on several mother gorillas and their infants. We found the gorilla family foraging high up on the east side of Sabinyo volcano. One mother followed another, some holding their infants in the crook of an arm, others carrying them on their back. One 2.5-year-old walked just behind his mother. The gorillas easily climbed a lichen-covered slope of rocks.

Turiho in Group 13, Rwanda; her infant is hidden behind the vegetation.

We followed until the group gathered for a brief rest period. Two mothers with young infants no more than 4 months old sat down next to each other in a small clearing. The tracker, Eric, looked at me with raised eyebrows to see if I knew who was who. I correctly identified Turiho, but drew a blank on the name of the other mother. Ah yes, Intambwe, I thought when Eric whispered her name. I should know her, having visited the day her baby was born. But nose prints still elude me. Turiho has long eyelashes and a delicate face; that's why I remembered her.

Two mothers in Group 13

The infants woke up and began squirming as they usually do when the mother rests. At first I could see only the tops of their heads. Then each mother sat back a bit and lowered her arms, giving the infants room to move. Turiho peered at Intambwe's baby and vice versa. I watched the hand movements of the tiny gorillas, comparing them in my memory to those of Ntobo's infant, who continues to appear strong and healthy despite the hair wrapped around his fingers. He's also several weeks younger.

Intambwe's infant in Group 13, about three weeks older than Ntobo's infant in Bwenge Group

Neither of the Group 13 infants pushed their bent wrists up into their mothers' armpits the way Ntobo's does. Both opened their hands and digits when they stretched out their arms. They nursed and bounced around a bit, as I've also seen Ntobo's infant do. They've doubled in size since I saw them in December, two months ago. Ntobo's infant is also growing. I've been checking him for three weeks, and he's noticeably bigger each time I see him.

Herd of buffalo near Bwenge Group, Rwanda

Monitoring Ntobo's infant has been a challenge. Getting a clear photograph of tiny fingers is difficult under any circumstances, but Bwenge has kept his group high among the brambles in a steep area dense with vegetation known as the backside of Busumba One, where there's lots of preferred food right now — thistle, berries and berry leaves, gallium and wild celery. The trackers also report that the silverback prefers to stay clear of the buffalo. This makes sense to me, given how many of the huge animals we saw the other day.

Nzeli's right foot continues to heal, though she walks gingerly.

Trekking is part of the job. I've learned that by keeping my mind clear and watching exactly where I put my feet, I can avoid most hazards on the main trail up to Karisimbi. But once we branch off to follow the gorilla's trails, I find myself thinking about the patients — Ntobo's infant and also Nzeli, recovering from her foot injury. Will they be better or worse today? Distracted, I inevitably slip on the wet plants and uneven ground. It's always a relief when we approach the group: even if the gorilla viewing isn't great, we can at least slow our pace, giving me time to avoid the thorns.

Ntobo's infant in Bwenge Group on Feb. 24, 2008.

I've spent a long time reviewing the pictures Elisabeth and I took of Ntobo's infant during the last three weeks. Now I'm beginning to think he may have tendon contraction in his hands and wrists, a form of birth deformity. This isn't a genetic defect but a congenital one, a problem that may have resulted from his body position inside the uterus. Alternatively, he could simply be guarding his painful hands. It's one of those chicken-and-egg questions to which we'll probably never find a definitive answer. Meanwhile, he continues to nurse and appears healthy otherwise.

Nzeli's foot two and a half weeks after the initial injury

I continue to feel glad I gave Nzeli the penicillin to halt infection in her foot. As expected, she still cannot walk normally almost three weeks after the injury and the group regularly waits for her to catch up. The dense vegetation and her improved condition have made photography of her feet even more difficult, but Nzeli usually takes at least one rest an hour — feet up. In the case of Ntobo's infant, we don't plan to intervene unless his hand shows signs of increased swelling or his overall behavior changes.

The sore right hand of Ntobo's infant

The camera is an invaluable monitoring tool in the field, but light and distance can affect the results. The middle fingers on the right hand of Ntobo's infant look worse in some photos than in others, while depigmented areas of skin on his fingertips (normal) make the swelling more prominent in bright light. In reality, the condition is unchanged and from every angle the tissue of the skin and fingernails shows no sign of breaking down, which means circulation is adequate. He also uses the hand, though it must be very sore.

Ntobo's infant on Feb. 24, 2008, almost 10 weeks old.

Naturally, we all wish we could just grab the infant, cut the hair off his fingers, and give him back to his mother! If the problem were human-induced or life-threatening, we wouldn't hesitate to intervene, even though that would mean anesthetizing the mother in the presence of a protective silverback. But our mission is to tend to a population of animals managed "as wild," and for now if the problem is considered naturally occurring and not critical, we can only watch and wait. Our checks continue.

[Rwanda, Feb. 24, 2008. Pictures: Dr. Lucy Spelman/MGVP]

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]

Nzeli Injured

Nzeli injured and resting before receiving treatment in Bwenge Group, Rwanda

I jumped out of my chair when my cell phone rang … so much for a quiet Sunday morning. First an earthquake — which had sent me running outside for fear that the roof of my little house would collapse — and now the phone. I glanced at my watch. It was 10:51 a.m. and the caller was Veronica, the field coordinator for the Karisoke Research Center in Rwanda. The combination could mean only one thing: emergency in the field. We typically hear of problems in mid-morning. Sure enough, Nzeli, an adult female had been found down, unable to move.

Nzeli picks up her injured left foot to inspect and clean the wound.

I quizzed Veronica while grabbing my field clothes, filling a baggie with raisins and slapping Band-Aids on my toes (a routine precaution). Hadn't Nzeli left Bwenge Group with a young silverback, Twizere? Yes, but she had just reappeared. It seemed she preferred to be with Bwenge. Were the injuries new? The trackers described a bad injury to one foot, with whitish tissue exposed. There had been several aggressive interactions between Twizere and Bwenge — maybe Nzeli had got caught in the middle. It sounded to me as if the injuries could be several days old.

Nzeli, alert but depressed, not eating and unwilling to move on the day her injuries were reported

I was the only gorilla doctor in town, but I knew Elisabeth (the vet tech who works for the park service, ORTPN) was in her office, working on a report. Bwenge Group wasn't far away. Elisabeth could join me quickly if needed. Nzeli's condition could be serious enough to warrant intervention with anesthesia, which we'd plan for first thing the following morning unless I found the gorilla in dire straits. I loaded our three medical bags into the truck and got halfway through our gate before I realized I'd nearly forgotten the penicillin.

At 1 p.m., I had my first look at Nzeli. She sat in a hunched position, occasionally picking at wounds on her hands and feet. When she got up to reposition herself, she used her knees instead of her feet. I could see a deep triangular gash across the bottom of her right foot and her toes were very swollen. She had a similar nasty wound on the heel of her left foot. Gorillas normally recover from fight injuries, but these appeared several days old and possibly infected. No wonder Nzeli hadn’t moved since the trackers arrived five hours ago.

Nzeli's injured feet the day after penicillin treatment

I called Elisabeth to discuss the options. We could intervene with anesthesia or antibiotics today, or wait until tomorrow and see if the gorilla's condition worsened — but we risked losing Nzeli. Twizere could challenge again; Bwenge could move quickly. She couldn't keep up. If we anesthetized her, our main goal would be to give antibiotics and clean the wounds We'd also be able to collect samples and prove or disprove infection. But the results take time. I chose to dart Nzeli with penicillin and recheck tomorrow.

Nzeli crawling away, walking on hands and knees, after receiving a dart of antibiotics

While I was preparing the penicillin dart, the group moved away to feed and Nzeli followed, crawling on her knees. We found her easily. She stopped to eat a few bits of vegetation — a good sign that she hadn't entirely lost her appetite. With the rest of the group far ahead, I knelt and waited for Nzeli to turn her head away from me. In just a few minutes, the opportunity came. She grunted when the dart hit, turned back to pull it out of her thigh and glance in my direction, then continued her slow crawl.

Nzeli examining her wounds

Elisabeth joined me early the next morning. I brought the full medical kit again, just in case. But I felt optimistic. Antibiotics are often highly effective, especially in our setting, where we use them sparingly. Unless Nzeli was much worse, we'd give her time to respond.

When we were about halfway up the mountain, the advance trackers radioed good news: Nzeli was with the group. We walked that much faster until we caught up to the gorillas. Nzeli looked remarkably better, still crawling, but her toes were less swollen and she was eating.

Nzeli four days after therapy, wounds healing

In appearance, Nzeli's wounds, while still very severe, looked healthier and more manageable, the kind that will heal on their own with plenty of cleaning and grooming — by the gorillas, of course.

The fact that Nzeli had regained her appetite also gave us confidence that she could keep up with the group. I was glad we'd made the decision to try penicillin and that it had worked. The pain wasn't gone, but the antibiotics had reduced her risk of developing a life-threatening infection and being left behind.

I was equally relieved that Bwenge and his group seemed so calm. Any time we intervene, there's the risk that the gorillas will become wary of visitors, especially of those who carry dart guns. I knew that neither Nzeli nor the others had seen me fire the dart — and that's the key to working with them as a vet: Hide the equipment. Yet they must smell the medicine at the puncture mark where the dart hit. I often wonder what sort of communication goes on after one of our very rare interventions.

Nzeli cleans her wounds

On the second day after the penicillin dart, Veronica reported that Nzeli had an even better appetite and could move more quickly, though still on her hands and knees. The gorilla had a bit of diarrhea, which we attributed to the antibiotic.

When I checked her on day three, Nzeli had begun to walk gingerly on her left foot while continuing to drag the right one. She cleaned her wounds, resting on her back and holding her damaged feet up in the air, exposing them to air and sunlight. Was my intervention with antibiotics necessary, given that our mandate is to intervene only when the problem is life-threatening or human-induced? I'll never know for sure. One thing is clear: she's better.

[Rwanda, Feb. 6, 2008. Pictures: Dr. Lucy Spelman/MGVP]

People Who Care

Susa Group mountain gorilla tracking and monitoring team, ORTPN, Rwanda

I smile when people say, "You're so lucky to be able to work with animals all day."

In fact, vets spend more time working with people than they do with their patients. Obviously, a sick or injured animal cannot speak, so we rely heavily on information that flows to us from those who work in the field as well as on outside experts. This is a good thing! The enthusiasm and compassion park staff and scientists show for the gorillas — the connections that develop between people and animals — are what fuel my batteries for work each day.

Kanama, a female mountain gorilla in Shinda Group, Rwanda

When the field staff describes a minor problem among the gorillas, we initially follow up with questions. I heard last week that two females in Rwanda's Shinda Group had watery diarrhea, and my first question was answered before I asked it: the gorillas weren't acting sick.

I asked if anyone had seen them eating unusual plants or feasting on a particular one, such as bamboo shoots, which can result in watery stool. No, not that anyone saw. Of course, they could have eaten something different before trackers arrived that day.

Pasika, a female mountain gorilla, with silverback Shinda, Rwanda

Fortunately, the Shinda females were perfectly fine the next day. If the problem had persisted, one of us would have made a monitoring visit to observe the animals and collect fecal samples. Our assessment in this case: mild, one-time diarrhea, two individuals affected, probable diet-related intestinal upset. Now we need to follow up and ask the trackers if there were any bamboo shoots around, though it's not currently the season for them in the Virungas.

Information-gathering is one reason we do routine health checks. We tend to hear more about the gorillas from colleagues and observers when we're in the field. And we usually find something we didn't know about or learn something new that might be important.

A small, seemingly minor problem can signal a bigger one; moreover, we're always on the lookout for communicable diseases — infections that can spread. These visits give us a chance to talk with park staff as well as an opportunity to observe the animals when they're healthy.

Blackback mountain gorilla, Gahinga, in Amahoro Group has minor wounds

I went on a routine health check visit to Amahoro Group the other day and noted that a blackback, Gahinga, had numerous scrapes on his face. He'd challenged the chief, Ubumwe, and quickly lost.

We don't typically intervene in cases of male-to-male aggression because this is natural behavior. In this case, the silverback was simply asserting his dominance, as long-time tracker Jean Baptiste confirmed. But it's helpful to know that this is a group where similar and potentially more serious encounters may become more frequent.

ICCN guide for Grauer's gorillas at Kahuzi-Biega National Park, DR Congo

Unfortunately, the situation in DR Congo has not yet stabilized. We cannot make any kind of vet check, let alone a routine one, to the habituated mountain gorillas on the Congo side of the gorilla park. Nor can we travel easily to the Kahuzi-Biega National Park to monitor the Grauer's gorillas there; the road outside Goma is unsafe.

We do continue to talk about their situation, hoping to become partners in the effort to establish a home for them in DR Congo, a sanctuary where MGVP would provide the health care. But until the security situation improves, we're not likely to make much progress.

Kwitonda Group tracker Jean with friends near the park
boundary with Art of Conservation banners in the background, Rwanda

The effort to save the mountain gorillas involves people who live and work outside the national parks, too. Here again, communication is vital. Our partner in art, Julie Ghrist, has printed banners with drawings and paintings created by Rwandans who took her free Art of Conservation classes. Now she's putting them up in the community — at local hotels as well as in the villages.

An Art of Conservation-MGVP banner shows destruction and protection
of the environment; artwork courtesy of Julie Ghrist and AoC team.

The artists combine scenes from nature with those that show the struggle of daily life, sending the message that although basic needs must come first people here do want to feel connected with the landscape and its animals. Unfortunately, this is a place where people suffer preventable disease and illness as well as poverty and war.

Is a healthy ecosystem possible in this setting? I don't know, but I do know that there are many people here determined to achieve it.

[Rwanda, Jan. 27, 2008. Pictures: Dr. Lucy Spelman/MGVP]