Quest: Mountain Gorillas: Discovery Channel

Following Umoja

For the better part of a week, I woke up at odd moments during the night thinking about Umoja and Nyiramurema. I felt sorry for the mother with her injured eye and missing foot, yet amazed by her strength and stamina. I wished we could relieve Umoja's pain. Magda told me she wasn't sleeping well either. Circumstances were beyond our control, as is often the case in wildlife medicine. We'd begun by worrying about whether we'd have a chance to treat the infant and waiting for the two gorilla groups to separate. After the intervention, we wondered if we'd operated in time.

After the Surgery: Disorientation

  After Umoja's successful surgery, his mother, Nyiramurema, headed downhill in the wrong direction as she tried to shake the anesthesia. The trackers quickly fanned out around her, forming a semi-circle to encourage her to reverse direction.

Umoja's Surgery

Nyiramurema and others groom Umoja.

We gave up trying to dart and treat Umoja after three hours. The group stayed together, and the opportunity to dart never came.

We did watch Umoja nurse, and we photographed his wounds. We could see holes in the exposed intestinal tissue and interpreted them to be in the omentum, the fatty tissue that covers and protects the bowel, rather than the intestinal wall. Had his intestines been punctured, we didn't think he'd still be alive, let alone have an appetite.

At one point, three gorillas gathered around the infant and groomed his wounds, licking and picking at bits of dead tissue. We could only hope we were right about those holes.

Umoja with Nyiramurema; parts of his small intestine
protrude from a wound in his abdomen.

Magda, Elisabeth and I returned to the forest first thing the next day. After spending another hour and a half in cautious pursuit, I finally had my chance. Nyiramurema sat down to eat a bamboo shoot. Umoja lay at her side. There were other gorillas nearby, but not Chiri. All were busy eating.

I darted the mother. She pulled out the dart, dropped it on the ground, got up and walked away to the next bamboo shoot. Five minutes later, she wobbled to her knees and fell asleep, anesthetized. I darted Umoja while he clung to her side. He too was unconscious a few minutes later.

Umoja anesthetized and ready for surgery

My job over the next hour or so was to keep the two gorillas safely under anesthesia, with Elisabeth assisting, while Magda did the surgery. Our operating theater was a tiny clearing surrounded by bamboo and vine-covered trees.

I felt a bit trapped, but also sure that none of the other gorillas in the area knew anything out of the ordinary was taking place. If we tried to move to a better site, they might hear us. The trackers stood quietly 30 feet away, listening for the rest of the group, ready to chase them away if necessary.

MGVP's Dr. Magdalena Braum prepares Umoja's injured abdomen for surgery;
he had several loops of bowel protruding through two puncture wounds.

Magda zeroed right in on the surgery. On Umoja's right side, she found not one but two canine-sized punctures through the skin into the abdominal cavity, with several short sections of bowel protruding through each one. Umoja's intestines were intact, but the skin had begun to heal around them, constricting the herniated tissue.

Magda removed small bits of unhealthy tissue, rinsed all with sterile fluids, released the pressure on the bowel loops, pushed them back in and then closed the wounds with buried sutures.

ORTPN vet tech Elisabeth Nyirakaragire treats Umoja with fluids and antibiotics.

While Magda worked, Elisabeth gave Umoja subcutaneous fluids and injections of antibiotics. I collected blood samples from him and Nyiramurema, satisfied that the anesthetic drugs (Medetomidine and Ketamine) were working well, but not entirely comfortable with the situation.

It's challenging enough to anesthetize one mountain gorilla, never mind two at the same time. I kept my focus on anesthetic depth, frequently checking both patients for an increase in muscle tone. If Umoja began to wake up, surgery would be disrupted. If she woke up too soon, we'd all be in trouble, given our cage-like OR.

Umoja lying next to his mother the day before surgery, favoring his injured right wrist.

Umoja's right wrist was badly damaged by a deep gash, more severe than we'd anticipated. One of two major flexor tendons running along the underside of the arm was severed and the joint capsule was torn open. The end of the ulna, one of the two bones in the lower arm, was exposed.

Magda sutured the tendons and a piece of muscle, knowing the repair might not hold but hoping to protect the tissue temporarily. Umoja may never regain full use of the wrist, but the wound should heal eventually. At worst, if the bones became infected or necrotic, he could lose his hand.

Umoja's right foot is curled as he guards the break in his leg
above the ankle; his left foot is uninjured.

We palpated Umoja's lower right leg and confirmed a fracture of both the tibia and fibula midway between the knee and ankle. While this injury is the least worrisome in terms of healing (young animals heal major bone fractures quickly), it is clearly the most painful. Umoja will not be able to walk, climb, play or feed normally for weeks.

While waiting for a chance to dart the day before, we'd watched as one of the other infants tried to start a game of rough and tumble. Umoja pushed his former playmate away, tucked his head and curled up in a ball.

MGVP's Dr. Lucy Spelman administers the anesthetic reversal to Nyiramurema
at the end of Umoja's surgery.

The scary part came at the very end of the procedure. As mother and infant recovered from anesthesia (I gave each a reversal drug), Nyiramurema started moving away in search of the group, stumbling a bit as she struggled to burn off the remaining anesthetic. Umoja rode on her back.

In her pursuit of a gorilla trail, she had to make her way through a dense thicket. Our patient hung on — at first. Unfortunately, Nyiramurema headed downhill, the wrong way. The trackers quickly fanned out around her, forming a semi-circle to encourage her to reverse direction.

To be continued …

[Rwanda, April 29, 2008. Pictures: Dr. Lucy Spelman/MGVP]

Gorillas Fight, An Infant Is Injured

Two-year-old Umoja hides in the vegetation. He was unable to move after sustaining multiple injuries during a fight between his family, Kwitonda Group, and Nyakagezi Group.

Jean Felix got the first call about Umoja. The 2-year-old mountain gorilla infant had been badly injured during a fight between his family, Kwitonda Group, and Nyakagezi Group. Sometimes these two groups interact peacefully, but not this time.

Umoja's intestines were hanging out and he couldn't walk. Jean Felix relayed the information to me, adding that trackers felt there was nothing we could do at this time. The situation was unstable and likely to remain so for several days.

We intervene with medical treatment when a problem is life-threatening or human-induced — and only then if we can act without undue disruption to healthy gorillas. It sounded as if Umoja needed surgery, which meant we'd have to dart him, and probably his mother as well, with anesthetic.

Kwitonda and his family were already nervous and would be especially protective of the injured infant. We'd need to drive them away with loud noises, adding to the tension and raising the risk of another aggressive encounter with the Nyakagezi gorillas.

With a broken leg, cut wrist and herniated intestines,
Umoja was able to crawl, but very slowly.

I knew we could do nothing until the gorillas went their separate ways, unless Umoja lagged behind. But I'd treated a similar case once before and knew the infant had a chance if he survived his initial injuries.

I asked for more history: "What was happening right now — was the infant alert, moving, vocalizing?" The answers all came back, "Yes." He was calling for his mother, Nyiramurema, to carry him. She'd picked him up a few times but hadn't held him for long. This female had lost a foot many years ago, probably from a snare, and had all but stopped carrying Umoja in recent months: He'd grown too big. His brother, Chiri, carried him instead.

Umoja clinging to his mother, Nyiramurema,
and surrounded by other gorillas.

As we later confirmed, Umoja had two puncture wounds in his lower abdomen, a broken right lower leg (tibia and fibula), and torn flexor tendons in his left wrist. Even so, he was able to hold onto his mother, nurse and crawl short distances.

I thought back to a Sunday morning emergency at the National Zoo in Washington D.C. The lowland gorillas had a fight and the youngest member of the group, an infant male, got caught in the middle. Though several loops of bowel hung from a hole just below his rib cage, his intestines had not been damaged. We closed the wound surgically and he lived.

Umoja's mother Nyiramurema

I suggested we check Umoja if possible and at least document his injuries. Jean Felix called Elisabeth, the park's vet tech. She agreed but warned we might not be able to get all the way to the group. I added surgical packs to our field kit just in case.

My mind flipped through the options as we drove to the park. Maybe the interaction between the gorillas would be over by the time we reached Umoja and we'd be able to intervene. We might be lucky and find him alone with Nyiramurema. She's blind in one eye, the result of another recent fight, which might enable me to get off a dart off without her seeing it.

An injured Umoja lies next to his mother.

We hiked about 40 minutes into the park and met the trackers. Instead of welcoming us with smiles, they looked serious. We found Umoja and Nyiramurema easily — but in the midst of other gorillas.

The infant lay uncomfortably at his mother's side while she nibbled on a vine. When she got up to move, he whimpered and reached out toward her. She picked him up once, but not a second time. He tried to follow, dragging his right leg. A bundle of red tissue bulged from his abdomen on the right side. Through our binoculars, Jean Felix, Elisabeth and I were unable to determine if the intestines were damaged or simply exposed.

Kwitonda and Nyakagezi Groups often interact, especially during bamboo-shoot season.

Light rain began falling. The mist rolled in. The Kwitonda Group gorillas formed a big circle, huddling together with females and infants in the middle to protect them from their would-be aggressors. We could hear the Nyakagezi gorillas in the bamboo nearby. We looked at each other in silent agreement: there was no way to intervene.

I tried to convey my apologies to the trackers. Umoja could live on for three, maybe five days. Watching him die would be hard and sad, but nature is not always gentle. We left for the day with plans to return if and when the trackers thought intervention possible.

Umoja nurses." />
Umoja nurses.

I spent the next morning reorganizing the field kits and lab supplies while I waited for an update, too distracted to sit down at my desk. The report came in mid-morning: the Kwitonda gorillas were still very nervous and had charged the trackers. The Nyakagezi gorillas remained nearby. Umoja could no longer drag himself along the ground and was being carried by his mother and several other gorillas, including Chiri. The good news: the infant was nursing.

Umoja, two days after the fight

On the third day, Elisabeth called from the forest. It was safe to intervene — the gorilla groups had gone their separate ways. Umoja appeared weak, she said, but continued to nurse.

Magda and I hurried to the site (Jean Felix was off for the weekend.) I made two darts, one for Nyiramurema and one for the infant. We began patiently following the group, waiting for the right time and place to fire the darts. It would do no good to anesthetize Umoja and his mother in a situation where another gorilla — mostly likely Chiri — might carry him off. And if I missed and the gorillas noticed, we'd only upset them again.

To be continued …

[Rwanda, April 29, 2008. Pictures: Dr. Lucy Spelman/MGVP]