Hands-on With Icyizere and Mushya

Magda, Jean Felix and I met to map out our intervention plan for Mushya. We would anesthetize only the mother to start with, then evaluate the infant as quickly as possible. I preferred not to anesthetize him unless absolutely necessary. His pale mucous membranes worried me. We couldn't draw many conclusions from a simple skin scraping, however. We'd need to perform as complete a work-up as possible. Our goal would be to collect as many routine samples from Mushya as possible, including blood, urine, feces and a skin biopsy.

Obviously, it would be a lot easier to do all this with anesthesia, but that seemed an unacceptable risk. Without any hair, Mushya's body temperature would drop rapidly the moment we took him away from Icyizere. We'd use hot-water bottles and hope for sunshine, but the recovery phase is always unpredictable in mountain gorilla interventions. The infant might not recover quickly enough to hold onto his mother as she woke up — or she might drop him, sensing something wrong.

Thoughts of Umoja's case ran through our minds (link). We had no way of ensuring that Icyizere wouldn't start off in search of her group and, in her haste, drop her infant along the way as Nyiramurema had done.

My feeling was that with Mushya so weak, we'd be able to do the procedure without anesthetic — that the main challenge would be to keep the mother anesthetized long enough to complete the planned exam.

Yes, we'd stress the infant by poking and prodding him, and if he cried out, Isabukuru, the silverback, might very well react. But since the mother is of much greater value to the population, the hard fact was that her health and well-being should take priority over that of the baby. We'd abort the procedure if there were any problems with her anesthesia. Everyone agreed with me, even though it meant we might not accomplish our diagnostic goal.

We made our final plan: both mother and infant would receive ivermectin in case the problem was mites. Mushya would be given subcutaneous fluids with B-vitamins and some oral iron, too. Magda would do the darting and then shift to do the baby's work-up and treatments with Elisabeth; Jean Felix would collect blood samples from the mother and other samples as possible; I'd take over monitoring the mother’s anesthesia and decide about any additional drugs for her and possibly the baby. I'd also take the baby's blood, since I'd learned to do this on an even smaller mountain gorilla, little Ndakasi, one of the Goma orphans, during her bout with pneumonia. We packed our kits. We were ready.

Blackback Kubaha sits calmly on the morning of Icyizere and Mushya's intervention.

The next morning we were off on time and made it to Isabukuru's group three hours later, just before 9 a.m. We had three of Karisoke's most experienced field staff to help the vet team: Emmanuel, Fundi and Bwarabwiza. They'd lead the effort to chase off Isabukuru and the rest of the family as soon as Icyizere went to sleep under the effects of the anesthetic.

Once again, we found Icyizere eating calmly, holding Mushya in the crook of one arm. Over the next 30 minutes, while we waited for our darting opportunity, Mushya scratched almost constantly. He seemed even itchier than he had the day before.

Magda's dart was perfect and Icyizere went down quickly. Isabukuru and the rest of the group milled around their sleeping family member, unconcerned by the extra people and, of course, unaware of what was about to happen.

As we later agreed, it was one of our easiest interventions in terms of crowd control. When the trackers raised their voices and sticks, Isabukuru was gone in a flash. So were Kubaha, the blackback; Muntu, another adult female; and the two youngsters, Ikaze and Isaro.

Lucy, Magda, Jean Felix and Elisabeth examine and treat Icyizere, who is anesthetized, and Mushya.

The rest of the procedure went almost precisely according to plan — including the need to make decisions about sample collection based on Icyizere's anesthetic level. She was stable, but her abdomen was full of food.

This is the disadvantage of field anesthesia, particularly when the darted animal is not sick. The longer we keep a mountain gorilla under anesthesia with a bellyful of food, the greater the risk of bloat and, even worse, regurgitation. The best way to prevent these dangerous complications is either to deepen the anesthesia and intubate the patient, or simply to finish up quickly. Twenty minutes into the procedure, we had to decide one way or another. My sixth sense told me to finish up.

Lucy taking a blood sample from Mushya with Elisabeth's help.

Sure enough, Icyizere sat up at 35 minutes, which is when the initial dose usually wears off. Magda had taken multiple samples of hair and skin scrapings from both gorillas and was about to do the skin biopsies. Since Mushya's skin showed only hair loss and no lesions, and Icyizere's skin also looked normal, these weren’t the worst things to miss.

Even so, our goal is to do a complete exam, and I think everyone felt a little disappointed. But as I reminded the team — and myself — later, we had everything else we needed, and both patients had recovered fine.

Magda takes skin scraping samples from Mushya.

Mushya had remained remarkably quiet throughout the procedure, even for the needle stick — perhaps a little too quiet. But we'd let him hold onto his mother firmly the whole time, and maybe that helped keep him calm.

He continued to hang on as Icyizere got up to leave. I gave her one more injection — the antidote we use to reverse the anesthesia completely. Holding Mushya carefully, she walked a short distance away, settling in a clump of vegetation next to the base of a tree.

Mushya holding onto Icyizere as she wakes up from anesthesia.

By the time we'd packed up our kits, Icyizere was sitting in the same place, fully recovered, and we could see at least one of her family members approaching from a distance. Thirty minutes later, as we ran down the trail with our precious samples, we heard Isabukuru beating his chest. The family had been reunited.

Jean Felix collecting a blood sample from Icyizere.

[Rwanda, 2009. Pictures: Dr. Lucy Spelman/MGVP]

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