Quest: Mountain Gorillas: Discovery Channel

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]

New Simple Tests for Humans Could Help Gorillas

Kwitonda silverback eats a stalk of bamboo.

A few months ago, I received an e-mail from Samantha Newport (then communications director at WildlifeDirect) with an offer of medical supplies from a woman in Switzerland, Jackie Sonderegger, who works for a company that makes medical diagnostic test kits.

Jackie was planning a stay in Mombasa, Kenya, and Samantha knew we'd save a bundle on shipping if we could coordinate getting the supplies to Kenya and from there to Rwanda. Jackie invited me to check out her company's Web site (http://www.doctorsdirect.md/Disease-Testing.html) and pick out what might be useful for the gorillas.

MGVP lab manager Jean Paul Lukusa

One of my goals has been to find tests we can run "in house" to screen the gorillas for diseases. For most samples, including those Jacques and Magda recently collected from Mapendo, we can do some tests in our regional lab — at least when the power is on! But we often wait weeks to months for other types of tests while permits are processed.

Various instant result lab tests have been developed for humans in recent years and I've been trying to learn more about them, especially those that screen for viruses and bacteria that cause respiratory infections. Our lab manager, Jean Paul, is more than willing to run new tests.

Jackie Sonderegger in the mail room at MD Doctors Direct in Switzerland,
preparing a box of supplies for MGVP.

To my surprise, the choices from Jackie's company included easy to use and instant result test kits for influenza, respiratory syncytial virus and streptococcus, all respiratory diseases that we worry about.

These tests use a Q-tip-like swab to take samples from the back of the throat or pharynx. The swab is placed in a special snap test chamber; the color change indicates a positive or negative similar to that of a pregnancy test (her company donated those, too!). I made a wish list and sent it back to Jackie, who responded immediately that she'd do her best to pull all the items together.

Grauer's gorilla Mapendo is bonded to her caretakers,
but even they can't place a swab up her nose.

Unfortunately, we won't be able to use these new tests on wide awake gorillas, even the orphans. Mapendo nearly bit a hole in my stethoscope the other day and I wasn't trying to put it anywhere near her mouth. But we can run the tests on samples taken from anesthetized gorillas. We can also use them for our employee health program. It's a long shot, but we might also be able to use these new test kits on other types of samples, like feces — the most easily collected gorilla sample.

Chimpanzee wadge of ficus fruit (fig) in Nyungwe Forest, Rwanda

The timing of Jackie's donation couldn't have been better for another reason. Recently, Mike and I accepted a summer student from Tufts veterinary school, Tierra Wilson, to work on a small research project on a technique for recovering saliva from uneaten bits of gorilla food. Tierra submitted a grant for her study and got it. She arrives in June.

If her study works, we could have a whole new type of sample to test. Though saliva is not a respiratory secretion, it does mix with fluids that come from the nasal passages and, if the patient is coughing, from the lungs.

The saliva recovery study is not a new idea and it may not work in gorillas. It's been successful in chimpanzees, but that species naturally leaves behind a perfect sample, a "wadge" (a word coined by Dr. Jane Goodall) of uneaten food. Chimps do this most commonly with fruits.

During my recent visit to Nyungwe Forest in Rwanda, we found fig wadges everywhere. By contrast, gorillas don't wadge their food at all and they have access to fewer fruits — and no figs. Until Tierra conducts her pilot study, we're not sure if gorillas leave enough saliva behind on a stalk of bamboo, for example, to recover as a sample.

Orphan Grauer's gorillas forage at the Interim Quarantine Facility.

When Tierra arrives, we'll ask the caretakers at Kinigi to collect uneaten bits of forest food from the orphaned gorillas for the first round of testing. She'll centrifuge it and run tests for the presence of saliva.

In preparation, Tierra has arranged through her mentors at Tufts to collaborate with the nearby New England Zoo that houses Western lowland gorillas. She'll test uneaten food samples collected from these animals and evaluate alternate methods of saliva sample collection, such as ropes or other objects for the gorillas to chew on that might retain bits of saliva. We may find these techniques don't work and/or that there's no way to apply them to free-living gorillas, but we won't know until we try.

An adult female mountain gorilla in Shinda Group
chews on a leaf she later dropped.

Though I'm excited about the possibilities of Tierra's study and Jackie's test kits, we have a number of hurdles to clear when it comes to verifying test results. Because gorillas and people are so closely related, we have good reason to believe the results are accurate. But to verify them would mean giving a rare creature a disease just to prove a test works, something we'd never do to a mountain gorilla. There's another challenge with the saliva recovery study in particular: Gorillas sick with respiratory disease often don't eat very well.

Letter of donation from Jackie's company sent in the hope
that officials would waive the customs fee; they didn't.

As it turned out, our first challenge was getting Jackie's test kits to Rwanda without paying exorbitant shipping. Because of the security problems in Kenya, Jackie never made it to Africa.

Instead, she offered to ship us the samples. Since FedEx turned out to be very expensive, Jackie suggested Danzas, a division of DHL. We said OK, not realizing that the shipment would arrive as freight and thus incur a customs fee. Even with a donation letter from her company, the Rwandan authorities would not waive the fee. Understandable, rules are rules. Jackie graciously offered to make a donation to MGVP equal to the amount we had to pay to get the box.

The tests arrived in time to run them on the little Grauer's gorilla orphan, Mapendo. Magda and Jacques had no trouble with the gorilla under anesthesia and all results were (thankfully) negative.

When Jackie offered to make a donation, little did she or her company know that the supplies would help get a small research study going and also give us new ideas about screening park staff and gorilla caretakers for respiratory diseases. As we learn more, we'll report back. Lots to do.

THANK YOU, Jackie and all at MD Doctors Direct. And thanks, too, to Samantha, for pointing Jackie in our direction.

[Rwanda, April 8, 2008. Pictures: Dr. Lucy Spelman/MGVP]

Mapendo Update

Mapendo falls asleep under anesthesia.

MGVP director Mike Cranfield and I were finishing up a meeting when Magda returned from Goma, where she'd spent the day working with Jacques.

"So, how's Mapendo?" I asked. Magda smiled broadly and replied, "A bit fat!"

She and Jacques had just given the orphan gorilla a physical exam under anesthesia. Even better, Mapendo's ringworm is resolving and she shows no signs of rickets, the nutritional disease that contributed to the death of her companion, Vumilia.

Dr. Magdalena Braum and Dr. Jacques Iyanya examine Mapendo.

Magda and Jacques had collected samples for a variety of routine tests, including fecal parasite check, blood cell count, serum chemistry analysis and infectious disease screening. They tested Mapendo for recent exposure to tuberculosis by injecting a tiny amount of a reagent, tuberculin, in her upper eyelid — a standard TB screening tests for primates.

They also vaccinated her for measles, rabies, tetanus and polio. We vaccinate the gorilla orphans in our care because they spend so much time with humans; it's easy to do and we can check on how well the vaccines work by measuring blood antibody levels in the future.

Mapendo eats clover.

The TB test is read at 72 hours, so we get this result quickly. If the gorilla has recently been exposed to the organisms that cause tuberculosis — either the human or bovine form — or has an active TB infection, its eyelid will swell. This test can be confusing, however. False positive reactions have been known to occur in gorillas exposed to related bacteria that live in the soil, requiring a battery of additional tests.

Fortunately, Mapendo's test was negative. We'll test her again in a few months and then every year she lives in captivity. With TB on the rise in human populations, I worry a lot about this disease. Not only is diagnosis difficult, but treatment requires daily oral medicine with a cocktail of drugs, a protocol that would be impossible to administer to the mountain gorillas of Virunga and Bwindi or to the Kahuzi-Biega Grauer's gorillas.

Mapendo with a caretaker in February.

Our lab manager, Jean Paul, ran a number of routine tests on the samples from Mapendo. He found a number of parasites in her fecal sample. Most healthy free-living gorillas carry some parasitic protozoa, worm eggs and larvae. But because they move around a lot, these parasites rarely build up in their environment.

This is not true for captive-living gorillas: because Mapendo lives in an enclosed space, her parasites could cause a problem someday. She'd already been treated with deworming medicine, so it's clear that she'll need to be on a regular regimen of parasite testing and treatment.

Mapendo soon after her arrival in January.

Jean Paul also found that Mapendo has high cholesterol — 195 mg/dl. Not too high, but above reported normal levels for captive western lowland gorillas and higher than what we've recorded for mountain and Grauer's gorillas.

We think the problem is her diet, specifically her three daily feedings of infant formula milk. Just as in humans, high-fat diets have been associated with elevated cholesterol levels and heart disease in captive-living western lowland gorillas. Mapendo needed the extra calories when she first arrived, but no longer. The caretakers will reduce the volume of milk and switch to a lower calorie formula.

Mapendo has an excellent appetite.

As noted earlier, another test to be run on Mapendo's blood samples is infectious disease screening. Here we look for evidence of exposure to a number of viruses as well as those we vaccinate against (after we give the vaccine, these tests will always be positive). Possibilities include herpes, Ebola, influenza and parainfluenza.

Unfortunately, sending samples to outside laboratories in the U.S. or Europe takes time. We need an export CITES permit first. In Mapendo's case, this document must be issued by officials in DR Congo. We've requested it, but know we'll have to wait.

Three Grauer's gorillas housed at the interim quarantine
facility, in Kinigi, Rwanda.

Though we can push through the red tape to expedite the permit process if the gorilla is sick or we're worried about a possible disease outbreak, Mapendo's situation doesn't fall into this category. We do need her results before she can live with other Grauer's gorillas, but that's still a distant prospect.

Last week, a number of the partners involved in orphan gorilla care visited yet another location in Congo that could be developed into a gorilla sanctuary. But such a facility is months, if not years away from becoming reality. And we still need an interim quarantine facility near Goma, like the one we have in Kinigi, Rwanda.

Mapendo's teeth

Mapendo's physical exam yielded one more important piece of data: her age. Though we'd photographed her teeth before (when her mouth was opportunistically open) we couldn't be certain of her dental formula without a hands-on exam.

Magda and Jacques confirmed that Mapendo has both of her upper and lower premolars but no molars, which places her age between 2.5 and 3.5 years. Given her size (she now weighs 35 pounds/16 kilograms) we think Mapendo is probably about 3. At this age in the wild, she'd still be nursing a bit, but would be mostly foraging on green plants and a few fruits. No wonder she's gotten a bit plump on all that milk.

Mapendo drinks water in March.

I visited Mapendo in Goma the week after her exam just to check on how things were going. The little gorilla avoided me.

Most small gorilla orphans can be distracted with a tiny bit of food or the offer of a bottle when it comes time for an injection. This strategy had worked well for Magda the week before when she needed to give Mapendo her anesthetic. A quick poke with a needle is easier than a dart . . . but the gorillas remember who stuck them. No doubt I reminded Mapendo of Magda: we're both white women with brown hair and when we visit the orphans we wear similar gear — masks, gloves and gray coveralls.

Jacques suggested we humans sit on the ground, which made a big difference. Mapendo strutted around a bit and climbed briefly on her tripod. Then she sat down in the shade next to one of her caretakers who plucked bits of clover from the grass for her to eat.

When the other caretaker crossed the enclosure to the night house to get her a bottle of water, Mapendo ran like lightning to beat him to the door and nearly succeeded. She drank the water as if it were an enormous treat.

I left feeling pleased to see Mapendo thriving, but sad that her future is so uncertain.

[Rwanda, March 31, 2008. Pictures: Dr. Lucy Spelman/MGVP]

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]

Death of an Orphan

WARNING: Graphic images ahead.

The orphaned Grauer's gorillas, Mapendo and Vumilia, in Mutsora, DRC,
on Jan. 10, 2008. Photo: Dr. Eddy Kambale

After 10 days of caring for the two orphaned Grauer's gorillas in Mutsora, we thought both would live. Vumilia was weak, but he regularly drank plenty of water and ate fairly well, especially fresh fruit.

We continued preparations to move him and Mapendo to Goma. Workers rushed to construct a temporary home at the Dian Fossey Gorilla Fund International (DFGFI) office there. The staff of the NGO WildlifeDirect arranged for a plane flight. Soon, we'd have all four orphans in one city.

Dr. Eddy Kambale and Dr. Magdalena Braum weigh the corpse of Vumilia. Photo: LHS

Thirty-six hours before the planned move, Eddy called me in the middle of the night. Vumilia had suddenly cried out and collapsed. Using CPR, Eddy managed to revive the young gorilla. I called Dr. Magdalena Braum, our new regional field vet who lives near me in Ruhengeri. We traded phone calls with Eddy, offering ideas and advice, hoping the problem wouldn't recur. But it did and Vumilia died. We'd be meeting a plane carrying one live gorilla — and one dead one.

Andre with Mapendo just after arrival in Goma on Jan. 14, 2008. Photo: LHS

Early on the day of the flight, Magda and I drove to Goma, stopping at the DFGFI office to check that everything was ready. Unfortunately, the walls of the outdoor gorilla enclosure still reeked of fresh paint and the newly poured cement floor in Mapendo's night house needed another day to dry. I decided that our part-time office space was the better — indeed the only — option.

Out went the desks and bookshelves and in went a mattress. When we let Mapendo out of her transport crate, she looked around calmly and walked straight into Andre's waiting arms.

MGVP vets Jacques, Magda and Eddy perform the postmortem on Vumilia
in a makeshift necropsy tent. Photo: LHS

With Mapendo settled, we began the postmortem on Vumilia. As with any complicated procedure, each of us had an assigned task. Magda and Eddy collected samples; I photographed; and Jacques recorded the findings and helped weigh or measure the various internal organs. The staff of DFGFI-Goma provided us with a makeshift tent; two of its sides open to the fresh air and a table. The flies found us quickly, however, making for a long afternoon. At least the weather was cloudy.

Vumilia had enlarged, deformed joints, evidence of severe metabolic bone disease. Photo: LHS

The little gorilla was emaciated and stunted. Though he'd been eating while under our care, he had no fat stores and his muscles were severely atrophied. His knees and elbows were abnormally large, the result of bony swellings characteristic of metabolic bone disease. Known as rickets in humans, this problem results when a young, growing animal is fed a diet too low in calcium or too high in phosphorus. Without access to sunlight, it develops more quickly. This condition, along with the scars around his wrists, suggested that Vumilia had been captive for many months.

Dissection of abnormal knee joints found during the postmortem exam on the
orphaned Grauer's gorilla, Vumilia. Photo: LHS

The gorilla's internal organs were pale in color with tiny pinpoint hemorrhages in some areas. We did not find any evidence of a communicable infection — good news for Mapendo and all who worked with Vumilia, though these findings are only preliminary.

Next we apply for permits, ship the samples to the University of California, Davis, and wait for the tissues to be analyzed by the expert veterinary pathologists. Only then will we be able to determine the cause of death. Sometimes, we never find out for certain what happened.

Clearly, Vumilia suffered from months of malnutrition, rickets and severe stress, all of which contributed to his death and may have been enough to kill him. We found a small amount of food – partly digested fruit – lodged in the gorilla's larynx, right at the opening to the trachea or windpipe. This could explain what happened at the very end. If the gorilla vomited a mouthful of food and choked on it, he may simply have been too weak to cough it out on his own. Eddy's CPR cleared the airway, but only temporarily. This is only speculation, but it's also our best guess until the final report comes in.

Mapendo eats ficus leaves; she has a probable fungal skin infection with patchy
and itchy areas of hair loss on her hands and body. Photo: Dr. Magda Braum

Three days after the postmortem, Magda returned to Goma to check on Mapendo as well as Ndeze and Ndakasi. Earlier, we'd noticed patchy hair loss on Mapendo; by the time of Magda's visit, the condition had worsened and the little gorilla was itchy. The problem looks like ringworm, so Magda started Mapendo on the appropriate medication. She and Jacques hope to confirm the diagnosis with analysis of hair samples.

Fortunately, the new orphan is taking her bottle quite well and shows no overt signs of rickets. Milk, sunlight and plenty of fresh browse will ensure that Mapendo does not suffer the same fate as Vumilia.

Jean Paul holds Mapendo; he and at least one other ICCN ranger have
joined the gorilla caretaker team in Goma. Photo: Dr. Magda Braum

Mapendo has two new caretakers, Jean Paul and Babo. Like Andre and the group caring for the mountain gorilla orphans, both are ICCN staff who have helped care for orphaned gorillas in the past — namely Pinga and Serufuli, two of the eight orphans who live at the Kinigi facility in Rwanda.

The rangers have been stuck in the city since last summer anyway. The situation in the Virungas section of the park is chaotic and the forest border is being destroyed by illegal charcoal manufacture. We have no news of the gorillas that live in the area.

Mountain gorillas Ndeze and Ndakasi are thriving in Goma. Photo: Dr. Magda Braum

I'm happy to report, though, that Ndeze and Ndakasi are doing fine, gaining weight slowly and playing most of the time. And the best news of all: both orphans have normal stool, formed and brown in color, rather than runny and white, and neither has had to be treated with antibiotics for several weeks — acidophilus did the trick. Now that they’re healthy, it was time to give them their vaccines. Magda and Eddy had the honor. Neither gorilla seemed to notice the needle stick. Apparently, Ndeze thought Eddy was just playing a game!

Ndakasi and Ndeze with their dedicated caretakers in Goma. Photo: Dr. Magda Braum

We've also started Ndeze and Ndakasi on a new milk formula, one I brought back from the U.S. that is supplemented with both fatty acids and probiotics. It seems crazy to pay extra baggage fees to transport tins of milk powder such a great distance, but the supply and selection of milk formula vary widely here. Thanks to the donations many people have made recently to MGVP, we can afford it. The caretakers are following a schedule, mixing the new with the old powder and gradually increasing the concentration. So far so good.

[Rwanda, Jan. 21, 2008. Pictures: Dr. Eddy Kambale, Dr. Magda Braum and Lucy Spelman/MGVP]

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 Gorilla Doctors

MGVP staff, from left: Jospin Mbonekube, Jean Paul Lukusa,
Dr. Jean Felix Kinani and Dr. Eddy Kambale.

MGVP's veterinary staff — collectively, the gorilla doctors — is a unique, diverse and interesting group of people. We differ in terms of our nationality, training and experience, as well as in the territory we cover. The in-country field vets are stationed in their home countries, either Rwanda, Uganda, or the DRC, while the regional vets and project director move about.

MGVP's regional headquarters is located in Ruhengeri (Musanze), Rwanda for two main reasons: Most of the world's habituated mountain gorillas live in Rwanda, and Ruhengeri itself is about halfway between the border with Uganda to the east and Congo to the west.

Dr. Lucy Spelman leads an MGVP team helping a wild giraffe at
Akagera National Park with an infected snare wound.

Though a subset of the six field vets will sometimes work together on a mountain gorilla when veterinary intervention is required, this happens only a few times a year. Typically, we are out and about alone or in pairs.

As regional director, I initiated monthly regional vet rounds so that the vets could get to know each other by sharing experiences and exchanging information. I also make the most of every opportunity to augment their training whether we're in the field or the office. The reality is that veterinary training in Africa falls considerably short of what we receive in the U.S. and Europe. When opportunities arise for mobilizing the entire team I go for it, as in the case of the giraffe in Akagera National Park (Rwanda) needing treatment for a snare wound [Mission Giraffe].

MGVP director Dr. Mike Cranfield also enjoys photography.

MGVP director Dr. Mike Cranfield was one of the first veterinarians to embrace the concept of "one health" (integrated medical coverage) and apply it on behalf of great ape conservation. Mike has led the project since 1999 and is always on the lookout for ways to build local capacity. MGVP has trained a number of in-country vets, helping several to obtain masters and PhD degrees.

Mike has also expanded MGVP programs to include employee and domestic animal health. His greatest challenge these days is raising the funds to sustain all of this important work. A Canadian, Mike currently lives near the Baltimore Zoo in Maryland, where he works as a research veterinarian studying avian malaria in South African penguins. His hobbies include competitive sailboat racing, ice hockey and squash.

Dr. Lucy Spelman, MGVP regional veterinary manager,
and ORTPN vet tech Elisabeth Nyirakaragire prepare for the field. Photo by Julie Ghrist.

I am the one American on the team, having grown up on an old dairy farm in Connecticut with a menagerie of animals. Even before I understood that such jobs actually existed, I wanted to be a doctor helping wild animals.

After college at Brown University, veterinary school at the University of California Davis, internship training in private practice and zoological residency training at North Carolina State University, I worked for the National Zoo in Washington, D.C. for nearly 10 years, first as a clinician and then as director.

But after 16 years as a vet, I'd still never treated patients in their natural habitat. That’s when I decided to apply for a job with MGVP as regional vet manager, a post I took up a little over a year ago. Aside from my work, I love to write, walk and read.

Dr. Jean Felix Kinani, MGVP Rwandan field vet, preparing to dart a
mountain gorilla with ORTPN vet tech Elisabeth Nyirakaragire.

Dr. Jean-Felix Kinani is MGVP's Rwandan in-country field veterinarian. Jean Felix received his veterinary degree from Check Anta University in Dakar, Senegal. He joined MGVP in 2004 and especially enjoys fieldwork with the gorillas. He is also interested in domestic animal health and recently started an annual rabies vaccination program for domestic dogs in the region. Near the Virungas there have been several recent cases of rabies in jackals and feral dogs; humans too have died of this disease.

Jean Felix is the project's great communicator. He speaks many languages, knows many people and has by far the highest cell-phone bill. His hobbies include playing and watching soccer, or football as it is known here. He and his veterinarian wife have just started a family.

Jean-Paul Lukusa, MGVP regional laboratory manager, teaches basic
hygiene at Art of Conservation class. Photo by Julie Ghrist.

Jean-Paul Lukusa is MGVP's regional laboratory manager. He received his degree in microbiology from L'Institute Superior Médicale in the Democratic Republic of Congo and then worked as a professor at a medical school in Rwanda before joining MGVP in 2003. Jean Paul lives in Goma, DRC, but commutes regularly to MGVP's main office in Rwanda. His duties range from running fecal parasite checks and bacterial cultures on mountain gorilla samples to administering the MGVP employee health program. The latter job involves coordinating doctor visits and laboratory samples for hundreds of park rangers, guides and patrols each year.

Jean Paul is MGVP's most gifted teacher and public speaker. And, as we learned when he participated in Julie Ghrist's Art of Conservation class (www.art-of-conservation.com), he can make even brushing one's teeth exciting!

Dr. John Bosco Nizeyi, MGVP research veterinarian and professor, at
Makerere University in Uganda.

Dr. John Bosco Nizeyi is MGVP's research veterinarian and a professor in the wild animal resource management department of Makerere University in Uganda. JBN (he's known by his initials) received his veterinary degree at Makerere, his masters of science in recreational resources from Colorado State University and his PhD in veterinary medicine at Makerere University in 2005. He has worked for MGVP since 1993, when he started as a field vet. His research interests include the use of fecal cortisol testing to monitor stress levels in wild animals.

Because JBN lives in Kampala, a long way from mountain gorilla habitat, and his days are full of teaching and guiding students, we don’t see him often. But when we do get together for an all-staff meeting in Kisoro, Uganda, everyone looks to JBN for his historical knowledge and experience.

Dr. Benard Ssebide, MGVP Ugandan in-country field vet, on a routine
health check in Bwindi Impenetrable Forest, Uganda.

Dr. Benard Ssebide is MGVP's Ugandan in-country field veterinarian and the team’s newest staff member. Benard (yes, this is the correct spelling) received his veterinary degree and masters of Science in wildlife health and management from Makerere University in Uganda. For six years, he worked for the Ugandan Wildlife Authority as veterinarian and chief park warden, based in Bwindi Impenetrable Forest. During that time he became a collaborator and friend of MGVP.

He joined the project early in 2007 to concentrate on field vet work rather than administration. Benard has a keen interest in wildlife diseases and will begin work on his PhD soon. With a home in Kampala and his patients spread out among dense jungle, Benard travels more miles over rough terrain than the rest of MGVP staff combined.

Dr. Jacques Iyanya, MGVP DRC field vet, monitoring
gorillas in Kahuzi Biega National Park.

Dr. Jacques Iyanya is one of MGVP's two in-country field veterinarians based in the Democratic Republic of the Congo. He received his veterinary degree from the University of Lubumbashi in the DRC then worked for the Department of Agriculture and Development in the eastern part of the country before joining MGVP in 2004. His duties include monitoring mountain gorillas on the DRC side of the Virungas and Grauer's gorillas in the Kahuzi-Biega National Park. He and his colleague, Dr. Eddy Kambale, also take care of the two newest infant mountain gorillas in Goma, DRC.

Jacques speaks perfect French, is exceptionally well connected and diplomatic and understands DRC's complicated political system. As a result, he often accepts the role of MGVP political adviser. He is rapidly learning English, and will soon be correcting me in my native language as well as in French!

Dr. Eddy Kambale, MGVP DRC field vet, helps care for
the orphaned mountain gorillas in addition to his field work.

Dr. Eddy Kambale is the other MGVP in-country field veterinarian based in the DRC. Eddy received his veterinary degree at the Catholic University of Graben, Butembo, in the DRC. Before joining the MGVP in 2004, he was a scholar at the Technical Institute for Agriculture and Veterinary Science in Butembo, DRC. In cooperation with Dr. Jacques Iyanya, Eddy’s duties include monitoring Grauer’s gorillas as well as mountain gorillas — and caring for the orphans.

He enjoys every aspect of clinical medicine, including pathology, or the study of disease after an animal has died. Eddy performed field necropsies on the gorillas shot in the DRC last July, hoping to learn something from this tragedy. Among MGVP staff, Eddy has a wry sense of humor and can make people laugh in any number of languages. At work, however, he’s seriously quiet.

Jospin Mbonekube is MGVP’s regional administrator
who helps coordinate the project in three countries.

Jospin Mbonekube is MGVP's regional administrator. He has worked for the project since 1999 and has managed to continue his university studies while working full-time. Jospin's workload has expanded significantly in recent years, perhaps especially since my arrival! His job includes just about anything — calling a plumber, inputting accounting data, arranging staff schedules. I often joke that we all work for Jospin, because he knows better than any of us where everyone and everything is at any one time. For every question he asks me, I ask another one back.

Jospin works in an environment where administrative headaches abound. Most of the time, however, he takes it all in stride. He is fiercely loyal to MGVP and stresses the importance of working as a team, even if it's easier at times to act alone. On some days, he is also MGVP's best dressed staff member.

MGVP's support staff, including Leon Ntahobavukira, the house
manager (left), eagerly help put the new truck's roof rack together.

MGVP's support staff includes long-time employee, Leon Ntahobavukira, the house manager. Felicien Mulinda, Faustin Nemeye and Samuel Nshimiyimana work as guards/grounds staff at the headquarters in Ruhengeri. Jean-Claude Rusengamihigo, Michel Mwemezi and Innocent Barimenshi perform a similar function at the interim quarantine facility (IQF) for orphaned gorillas in Kinigi, Rwanda.

MGVP employs five of the seven caretakers who work at the IQF: Amiel Bapfakwita, Dieu Donne Muyambabazi, Jean Baptise Bisenigamana, Innocent Kabendera and Fabian Bahati. The project also pays part of the salary for Simon Childs, IQF manager.

[Rwanda, Nov. 28, 2007. Pictures: Lucy Spelman/MGVP]

A Holistic Health Approach

A marshy clearing surrounded by bamboo in the
Sabinyo Group habitat, Parc National des Virungas, Rwanda.

When I was on a routine health check to Sabinyo Group last week, one of the trackers, Leonard, spotted a snare in the bamboo thicket to the right of the trail. It was a typical model: a rope tied at one end to a stalk of bamboo and made into a loop at the other end with a slipknot. This loop lies flat on the ground, a wooden stake holding it in place so that there is tension on the rope — enough to bend the bamboo horizontal. Leonard stuck the blade of his machete in the loop to spring the trap. Startled, I ducked just in time to miss the bamboo as it whipped back up. He untied the rope and put it in his pocket.

A bushbuck antelope disappears into thick vegetation.

Minutes ahead on the trail, another tracker, Jeanipo, found a second and a third snare; then Leonard a fourth. "Enough," I thought; "I don’t like these things. How can there be so many in a park that is highly patrolled and visited daily by scientists and tourists?"

So far, I've managed to photograph only the rear end of a bushbuck, but there's no question that the park is full of antelope. We see their tracks often. I asked Leonard and Jeanipo how many snares one would have to set to catch a bushbuck or a duiker (never mind a gorilla). The answer: five catches three. While the trackers made a radio call to the patrol team, I tried not to envision a dozen more Magayane cases.

An African elephant forages on bamboo in the
Group 13 habitat in the Parc National des Virungas, Rwanda.

We continued on the trail. Suddenly, several very fresh elephant tracks appeared. I held my breath, thinking we might actually see an elephant. That would be amazing luck, given that I've seen only one, three weeks ago on a routine visit to Group 13. I'd learned that day that elephants and gorillas sometimes travel together, often in the morning. But the huge prints disappeared from the trail after a short distance and my thoughts returned to the snares. They seem too small to harm such a huge animal, but I know of one elephant here that may have lost its trunk to a snare last year.

Gihishamwosti, a young male mountain gorilla in the Sabinyo Group,
has wounded toes on his left foot.

As we caught up to the Sabinyo Group, the gorillas left the bamboo area and crossed the marsh to a small water hole. Leonard announced that one of the young males, or black backs as they are called, Shirimpumu, had a wire snare around his toe last week. The gorilla had removed it himself, no problem. But while they gathered around the water, I noticed that another black back, Gihishamwosti, had a toe injury. He was missing two toenails on his left foot and his big toe was swollen. The problem was minor and very likely a random injury or a wound suffered in a fight. Then again, he too could have been caught in a snare for a short while.

As I understand it, gorillas rarely drink water for any length of time. But this group spent five minutes at the water hole. Watching them drink, my mind shifted to the issue of disease. We'd been talking earlier in the week about MGVP goals for the future and had agreed that the project should work harder to exchange information with local public health officials, district veterinarians and lab technicians in order to create a better network for alerts of disease outbreaks that could spread to the gorillas. One of the easiest routes of disease transmission is water.

Tourists visit a habituated mountain gorilla group in Rwanda, Park National des Virungas.

It's not always obvious to people why the mountain gorillas are at risk of disease or why they need vets. After all, the animals live in a protected area. But from an everything-is-connected or integrated health point of view, the gorillas are healthy only if the humans and animals in their ecosystem are also healthy. Thus, another of MGVP's future goals is to share the reasons for existing health regulations and to make recommendations to strengthen them if necessary. Tourists are asked to keep their distance, for example, because they've been in airports and crowded places. Even a common cold can make the gorillas sick.

Members of Pablo Group outside the Parc National des Virungas, Rwanda.

We also agreed that MGVP should continue to offer employee health screening programs for trackers, rangers, guides and scientists. There's every reason to screen this group of people carefully, considering that they spend hours with the gorillas. But the biggest challenge is how to protect the gorillas in the face of a disease outbreak in the villages near the park boundary. When the gorillas leave the park to forage for thistle or eucalyptus, there's always the chance that they may move into an area where flu or measles is active. We need better information exchange with health officials so that more people understand the risks.

A domestic cow inside Akagera National Park, Rwanda.

Cows can carry tuberculosis, brucellosis and a variety of intestinal parasites and bacteria that can be harmful to other animals and humans. When we went to Akagera Park last week, looking for the giraffe that whose snare we'd removed several months ago (Misson Giraffe), we saw cows everywhere, both inside and outside the park. Though the main focus of MGVP vets will always be gorillas, we also talked in our meeting about ways to improve domestic animal and livestock health. We agreed that another goal should be to help train more domestic animal vets in the region.

Giraffe, Akagera National Park, Rwanda

As for our giraffe patient, though we never found him, the rangers and guides reported seeing him a few days earlier. They said he looks a bit thin and still has a limp, but they described a wound that sounds as if it's healing slowly. His case underscores yet another need in this region — more trained wildlife vets. Again, this isn't something MGVP can do alone, but it can help by establishing a network of experts and helping when time and resources allow. We hear Akagera Park will soon hire its own vet. Maybe he or she can help us find our patient next time.

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

Magayane Performs Her Own Surgery

Magumu, a subadult female, is missing all four fingers on
her right hand due to an old injury — probably a snare.

Three weeks after we removed Magayane's snare (see Snare Scare) I made a return visit to Kwitonda Group to check on her recovery. Sadly, she's one of dozens of mountain gorillas maimed by traps set by poachers. Some have been patients of MGVP at one time or another. Others were injured before the groups were habituated for tourism. In this family, there are two other gorillas with noticeable old injuries: Magumu, another young female, is missing four fingers on her right hand.

Nyiramurema is missing her left foot due to an old injury — probably a snare.

Nyiramurema, Umoja's mother, has no left foot, though she compensates extremely well. She and Magumu, along with Magayane and the rest of the Kwitonda Group, moved from DRC to Rwanda a few years ago. We don't know for certain what happened to them before their arrival, but it's likely they encountered poachers. When gorillas fight, they tend to inflict deep lacerations that leave a scar, rather than a neatly severed digit or limb. Kwitonda himself has two bent fingers on one hand and is missing a finger tip on the other — he could have been caught in a snare or involved in a fight. Both would have been reasons to move.

After an easy half-hour's walk into the park the trackers found the gorillas just waking up. Within minutes the entire Kwitonda Group had disappeared within an enormous vine-covered tree. The combination of low light and leaf shadow made it impossible to see much of anything. Craning my neck and squinting, I could see only the dark outline of the silverback about two-thirds of the way up. The trackers spotted Magayane's head at one point, but there was no way I could see her fingertips. Not to worry — no tree lasts long with 16 gorillas in it.

Magayane favors her left hand, injured by a snare three weeks earlier.

The trackers led me around to the other side of the tree, anticipating where Magayane would appear next. She's usually somewhere near the younger gorillas, grooming or playing with them. It wasn't long before the infants and juveniles slid out of the tree, hanging onto branches until they gave way, then tumbling to the ground. Kwitonda followed with three females, including Magayane. The group sat down in a small clearing for a grooming session. I didn't need binoculars to see that her finger was in worse shape than I’d expected.

A close-up view of Magayane's injured finger.

Pale white tissue — dead bone — protruded from the end of Magayane's left middle finger. I nearly said "Ouch" out loud. The trackers had reported earlier that although Magayane's damaged finger looked a bit swollen and discolored, she was eating well and acting normally otherwise. They hadn't seen the exposed bone until today. Magayane favored her injured hand, but she also seemed to be functioning pretty well. I watched her groom Umoja; she simply held her sore fingers out of the way. Then she rolled over on her back to rest.

Obviously the snare had damaged the superficial structures of her middle finger — the skin and nail — as well as deeper ones, cutting off the blood supply to the bone. The quickest way to resolve this problem was surgical amputation. On the other hand, gorillas recover fairly quickly from digit injuries and Magayane had a good chance of healing without complication, and without another intervention procedure. If infection set in, we'd reconsider. There was no reason she should lose more of her hand than she had already.

The next morning, Elisabeth and I returned to the group. When we got our first close look at the damaged finger, Elisabeth reacted as I had the day before — she raised her eyebrows and suppressed an exclamation. The wound didn't look any worse to me. In fact, it looked a bit better. I could see healthy pink tissue at the base of the exposed bone instead of the crusty dark tissue from the day before.

Magayane treats her own wound.

Elisabeth reminded me that gorillas spend a lot of time treating their own wounds. They'll pick at a wound to help keep it clean, and others will join in. Just at that point, Magayane lay down on the ground near us and put her finger in her mouth. This time, I did say "Ouch," and added, "Yikes! That must hurt." We could see that the end of her finger, the bone segment called P1, was somewhat mobile. That was a good sign, though it must be giving her a lot of pain. The sooner this piece disarticulated and fell off, the better.

We watched the gorilla work on the wound with her tongue and teeth. She was trying to break through the strands of tissue holding the joint together -- a strategy identical to surgical amputation, though we of course would use a scalpel blade or a scissor to cut the ligaments. I whispered to Elisabeth that Magayane no longer needed us vets. She’d needed us to get the initial snare off, but from here on, taking care of the injury was well within her abilities.

Magayane used the fingertips of her right hand to pick at the wound for a while, then put the injured finger back in her mouth. Fascinated by her behavior, I decided that this case was worth monitoring every few days or so until it resolved, so that we could photo-document the progress. Had Magayane been a nervous gorilla, this wouldn't have been possible. The movements and range of the Kwitonda Group also made tracking her relatively easy.

Jean Felix visited next and reported that the bone was still there. I went again the next day, hoping that Magayane — and time — had finished the job. On my way up to the park, I picked up several of the trackers in our truck. I often give them a ride when we join them for a monitoring visit. After saying good morning, I asked about the finger. The answer: "Tombe" ("fallen" in French). Finally, the tip had fallen off. The surgery was over.

Sulubika, a juvenile in Kwitonda Group, helps Magayane clean her wound.

Not only did Magayane continue to treat the wound on this day, several other gorillas joined in. Sulubika seemed particularly interested. Grooming is a huge part of gorilla social life, and treating wounds is simply a part of this natural behavior. So none of what I was seeing was new to the gorilla experts. It was just a new experience for me. The gorillas need the vets for some problems — removing snares or treating pneumonia, for example — but not for others.

Watching Magayane perform her self-treatments, I couldn't help comparing her physical toughness and pain tolerance to those of a human. The sight of her working at the fingertip made me cringe; yet five minutes later, she'd be asleep, playing or eating. On one occasion, after finishing a treatment, she paused to look around. Raising her body on one elbow, the gorilla stretched out her arm and rested her injured hand on her knee. Someday, I'd like to send that photo to the poachers.

[Rwanda, Sept. 20, 2007. Pictures: Lucy Spelman/MGVP]

Ndakasi: Small, but Strong

This week, Ndakasi was on my list for a follow-up health check. All reports were that the orphaned mountain gorilla had been doing well, taking a full bottle at each feeding and steadily gaining weight. According to Eddy, her primary vet, she'd even begun to resist her daily physical exams — a great sign that she was getting stronger.

It was hard for me to imagine her as a feisty little gorilla. The first time I met her she was very ill and weak. The second time, she was just barely able to take her bottle and needed oxygen around the clock.

I was excited during my drive to Goma and looking forward to seeing Ndakasi feeling well rather than at death's door. We'd set up an intensive-care-style schedule of health checks and Eddy had been sending us the results of her physical exams. But those were reports on paper. Today was my chance to see her recovery for myself and there were a few things I wanted to check carefully.

My main goal was to get a follow-up blood sample. It had been three-and-a-half weeks since we first diagnosed Ndakasi's pneumonia. I'd gotten a tiny amount of blood then and saved it; by taking a second sample now, I'd have what we'd need to run paired titers. This special set of lab tests might ultimately reveal which virus or other microorganism had caused the baby's illness.

She had been anemic last time I visited and I hoped we'd see her red blood cell numbers go up today. I also had concerns about her body weight -- at about nine pounds, she's small for a four-month-old mountain gorilla. She had been drinking full-strength formula for only a week before she became ill, and was underweight even then. It takes a lot of calories for a healthy infant, let alone a sick one, to maintain its body temperature, and her metabolic rate had probably doubled during the illness. This is one baby who can't afford to get sick again any time soon.

The weather made me worry about Ndakasi's hydration. It's very dry in Goma — the town is at a lower altitude than the Virungas —and now it's the dry season. Instead of a wet and misty drive, my trip to the Rwanda/DRC border was dusty. The difference was striking, almost as if I'd gone to a different country. My hair is always a good measure of humidity. Curly in the wet season, it's now almost straight. Instead of slightly frizzy, moderately short hair, I have long straight hair that keeps falling in my face.

Infants lose body fluids as easily as they burn calories. The humidified air produced by the oxygenator machine and the nebulizer definitely helped Ndakasi stay hydrated. But she wouldn't tolerate the treatment anymore. She'd learned quickly how to push the hosing away from her face with her tiny hands, diverting the moist vapor. Now that we'd gotten her through the illness, my sense was that her entire system would be better off in a natural environment. I thought I'd suggest to Eddy that he attempt the homemade eucalyptus leaf humidifier therapy only once in a while.

Lastly, I wanted to be certain that the variable blood oxygen level readings Eddy was recording were due to the baby's movements (the sensor doesn't work well with any type of motion) and not residual problems with her lungs.

Eddy had reported that Ndakasi wouldn't hold still for anything these days. It was taking him as long as 30 minutes just to complete a single "TPR" (temperature, pulse and respiration) without stressing her. When the gorilla was weak, she allowed Eddy to do these brief exams in just a few minutes. He could wrap the pulse oximeter sensor around her thumb and she’d ignore it; now she pulled it right off.

I hardly recognized Ndakasi when I walked into the room. She was bright-eyed and she'd grown noticeably since my last visit. I think Andres (one of her caretakers) could tell I was smiling, though my mask hid most of my face. Like all baby animals, she gazed back at me with an endearing expression.

The calm didn't last long, however. Ndakasi wanted nothing to do with my stethoscope or the oximeter — just as Eddy had reported. When it was time for the blood sample, she let me know exactly how well she was feeling: she squeaked, chirped, struggled and even tried to bite Andres! She was such a strong, moving target that it took me three sticks to get the complete sample.

She recovered quickly once back in Andres' arms, though she may very well remember me next time as the not-very-nice white ape with the needle.

Back in the lab, we found that her anemia had resolved. Now we just needed to get permits from the various governments to send mountain gorilla blood samples out for analysis. That's a whole separate project, but it could add valuable information to what we know about respiratory illnesses in mountain gorillas. At least we can take Ndakasi off the active patient list.

Sadly, I've just learned that there's been a tragic incident in the DRC like the one that orphaned Ndakasi. Wild mountain gorillas have again been shot to death and at least one infant left motherless — Ndakasi now has company.

To be continued. . .

[Rwanda, July 16, 2007. Pictures: Lucy Spelman/MGVP]