Quest: Mountain Gorillas: Discovery Channel

Rechecking Mushya

During my recheck of Mushya and Icyizere the day after the intervention, I kept an eye out for fresh fecal samples. We wanted to follow the pattern of parasites now that we’d given the ivermectin. Icyizere had conveniently produced several samples within minutes of my arrival in the group. I’d brought one of them back to the lab for microscopic examination. I found — no surprise — that it was still loaded with parasites. But I had the impression that there were many more worm fragments than whole ones. Maybe the ivermectin had already killed some of the adults.

Mushya: Lab Work and Follow-Up

After a brief break for lunch, Magda, Jean Felix and I met back in the lab to evaluate Mushya’s case. We spent the next five hours doing all we could to process and run the gorillas’ samples, but we ran out of energy before we could finish. I think we also felt a bit deflated when we didn’t find mites in the hair or skin samples.

But we did discover one new, important fact: Icyizere was anemic, too, although not as severely as Mushya. This meant the mother's health could also be a factor, something we hadn't suspected.

Security Concerns

The other night I was one of several guests at a small dinner party in Rwanda. It had rained all day — and most of the previous night — but the skies had cleared about an hour before dark. It was the first time in weeks I'd driven up the road to park headquarters, having been on a break in the U.S. to promote Ted's and my new book. I drove slowly, swerving to avoid bicycles, pedestrians, goats, mini-buses and the occasional pollution-belching truck.

Another Wire Snare (Part 2)

Benard and I left early for our new snare case. We were on the road to the ranger station at 6 a.m., hoping to catch up with the gorillas by 9 or so. Any time we intervene with anesthetic, it’s best to get an early start. We need time to get the dart in, perform the procedure and wake the patient up; and in this case, tourists would be arriving by late morning.

Another Wire Snare (Part 1)

When I first read Benard's email, I didn’t want to believe it. A blackback in Nkuringo Group had a wire snare around his leg. The gorilla had continued to eat, but he'd begun to fall behind the group. One of us needed to cross the border to Uganda before closing time, stay in Kisoro for the evening, and leave for the forest early the next morning to deal with the snare. The drive would take two hours, followed by another hour's trekking.

Another Sick Infant

I've been back in Rwanda for several weeks. As always, I spent two of them in self-imposed quarantine. Any time one of the vets travels on an airplane, we risk exposure to infectious diseases carried by fellow travelers. Though I wash my hands often and stay away from people who appear sick, it's impossible to eliminate the risk.

Tierra's Summer Project: Gorilla Saliva

For the past two months, we've been working out ways to collect and store saliva from gorillas. In the future, we plan to test these samples for diseases, especially the viruses that cause respiratory illness. This study has been a good idea in our heads for some time. Thanks to veterinary student Tierra Wilson, it's finally under way. Tierra not only designed the research project, she found her own funding to come to Rwanda and run it!

Coughing and Sneezing in Susa Group

I'll always remember the day Umoja yelled at me and then crawled swiftly toward his mother on two elbows and one knee. Five days after surgery, he no longer needed our help. Nothing in his behavior or appearance suggested that a second intervention with antibiotics would be necessary. My own feet felt light that day as I scrambled down the rocky path out of the forest — until I spoke to Elisabeth. She'd just received worrisome news from the trackers in Susa Group: four gorillas were coughing.

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.

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]