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Umoja Checks Continue

Umoja with his gorilla family - 3 days post-op

Grooming session with Umoja, Nyiramurema, Kwitonda, and others.

Six days after Umoja’s surgery, Magda returned from checking on him with a worried expression. Her report sounded exactly like mine from the day before: he was alert, whimpering, crawling, nursing well, and nibbling—but not swallowing—bamboo leaves. Umoja could still develop complications, and we’d both hoped his appetite for solid food would return by now. He could have an abscess brewing in the muscle layer where we’d placed the sutures, or the wound on his wrist could become infected. Or—the worst possibility—his intestinal tract might be damaged. He could have a stricture.

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Umoja riding on Nyiramurema’s back favoring his right leg.

Alternatively, Umoja may simply be content for now with the milk and comfort of his mother. Because of his broken leg, he’s unable to wander around, try out new foods, or play with other infants. His behavior resembles that of a very young infant rather than that of a two-year old. Maybe he simply lacks the energy to manipulate bamboo. He burns extra calories every time he crawls after his mother. Moreover, the healing process increases metabolic rate. The pain from his wrist and leg may make him too uncomfortable to eat. Still, we worry about intestinal pain or cramping if he does have some scarring.

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Umoja resting with Nyiramurema.

Elisabeth checked Umoja one week after surgery, a time frame we viewed as a mini- milestone. She and the trackers started out expecting to find Kwitonda where he’d been all week, close to the park border. Instead, they found evidence of a fast-moving journey up the mountainside. They could hear hoots and chest beating. Nyakagezi Group was back, and Kwitonda was on the move, following them. Elisabeth and the trackers stayed with the Kwitonda group for several hours. Fortunately, there’d been no fighting. Nyiramurema carried Umoja most of the time. If she put him down, another gorilla immediately picked him up.

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Grooming session with Umoja, Nyiramurema, and silverback Kwitonda.

Nine days post-surgery, I made the next recheck. We were early, and found several gorillas still in their night nests. Kwitonda was resting on his elbows. Nyiramurema walked over to him, leaving Umoja sitting quietly about ten meters away. As she started to groom the silverback, the infant got up to join them. Instead of crawling, he walked on both hands and his left foot, favoring the right hand a bit and holding his right leg entirely off the ground. He made no sound. I was relieved that at least he could now limp normally!

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Umoja, nine days post-op, riding on his mother’s back.

I decided to continue on and do a routine check of the entire group on this visit. While picking my way through the bamboo with Leóndace, I temporarily lost track of Umoja. By now Kwitonda was sitting in a shady thicket with several juveniles playing around him. I had my binoculars focused on this group when I heard a familiar noise to my left: gorilla crashing through bamboo. Nyiramurema appeared out of nowhere, only a few meters from me. She stopped and stared at me for a few seconds, then moved quickly toward Kwitonda. Umoja crawled from where he’d been sitting, hidden from view, and climbed on her back as she moved away into the thicket.

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Umoja climbing up on his mother’s back.

I looked at Leóndace. He didn’t seem concerned. Nyiramurema’s behavior was natural and normal. She’s always been a very protective mother, and we’d unknowingly broken a basic rule–never get between a mother and her infant, let alone an infant you’ve darted. But after silently chastising myself, I realized our blunder had yielded a positive piece of information about Umoja I hadn’t yet picked up on: he’d been where a normal, healthy gorilla infant should be, playing near the silverback while his mother foraged.

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Umoja, nine days post-op, with Nyiramurema and Kwitonda.

Unless something happens to Nyiramurema, Umoja will survive his injuries. He may have a visible a wound at the surgery site for some time, and bits of suture may migrate out. He may never walk completely normally, or recover full use of his right hand. But the fact that he managed to survive those first few days before our intervention shows he’s every bit as strong as his tough-as-nails parents. He kept his appetite for milk even with his intestines sticking out, and had enough strength to drag a broken leg behind him while holding onto his mother’s back with one good arm and leg. As Magda remarked, if Umoja lives to be a silverback, he’ll be quite something.

Following Umoja

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Nyiramurema carrying Umoja one year ago, Kwitonda Group, Rwanda.

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.

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Umoja in June 2007, a healthy infant in Kwitonda Group, Rwanda.

Only during the two hours when the gorillas were anesthetized were we in control. It was clear that Umoja was slowly dying. Surgery was his only chance, despite less than ideal conditions for a procedure involving an open abdominal cavity. Both puncture wounds went through skin and muscle straight into the abdomen. They’d begun to heal, clamping down on his intestines. We did our best—Magda and I, Elisabeth, and the five trackers, Pierre, Peter, Leon dace, Aaron, and Jerome. But was it good enough?

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Nyiramurema with Umoja after his surgery, Kwitonda Group, Rwanda.

As soon as the infant and his mother rejoined the group, our ability to influence the outcome ended. We could give Umoja more antibiotics after 72 hours, if we felt it would make a difference and if we could get a dart off; but the main event was over. If he suddenly weakened or the wounds reopened, it was unlikely that we could or would intervene a second time. Vets have post-operative control of their patients in many situations, especially when the animal can be confined or hospitalized, but not in this one. The next few days were up to the two gorillas. Umoja would either heal or develop complications. His mother would continue to carry him and let him nurse—or not.

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Kwitonda silverback with his family, February 2007, Kwitonda Group, Rwanda.

Magda checked on Umoja the day after surgery. When we’d left the group after the intervention, we felt optimistic about his immediate survival, but I didn’t relax until she called with an update. The trackers had found the group near where we left them—in a shady stand of bamboo. Umoja was clinging to his mother and his surgical wound looked intact. Not unexpectedly, Kwitonda had singled out Magda and displayed with a false charge, letting her know that he knew something had happened. Nyiramurema was nervous, too, though she allowed Umoja to nurse in front of Magda. So far, so good. Magda kept her visit short, knowing the gorillas would relax if left alone.

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Umoja, 2-days post-op, riding on his mothers back as they leave their night nest.

The next day I did the Umoja recheck. As we walked quietly through the forest, I could sense the trackers’ relief. They’d observed the infant nursing many times during the previous day after Magda’s visit, and he’d regained some strength. I heard Umoja whimpering even before we reached the gorillas, who were just leaving their night nests. The sound was a good sign. He’d been too weak or depressed to make any sort of vocalization for three days. I snapped my only photo of the day (it was too dark further inside the forest): Umoja riding on Nyiramurema’s back, bright-eyed and alert.

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Kwitonda silverback, Kwitonda Group, Rwanda, May 2008.

We followed the group slowly, in the hope that I could get a good view of the abdominal incision. Akareveru, the older of two black backs, felled a tree filled with flower buds and began to eat. Several other gorillas moved in to join him. Suddenly, Kwitonda appeared out of nowhere and ran at us. He stopped just a meter away, puffing out his upper lip and glaring at me. I stepped behind the tracker, Pierre; the silverback moved forward, backing us up further. I was aware that Nyiramurema was approaching from the left, and clearly Kwitonda was, too. I got the message: he knows me as well as Magda, and isn’t happy about either of us. As soon as the female sat down to eat, Kwitonda did the same.

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Umoja, three days post-op, riding on his mother’s back; his surgical wound is healing.

Nyiramurema didn’t seem to notice me, or if she did, she felt safe in Kwitonda’s presence and showed no reaction. She pulled up a bamboo shoot and let Umoja slide to the ground. He rolled onto his back and lay quietly. Through my binoculars I could see that the skin around his incision was puffy and moist on the surface. A major concern has been that the sutured tissue will break down, or dehisce. Since we expect some inflammation at 48-hours post-operatively, this was no cause for worry, especially given that other gorillas had undoubtedly been picking at the wound.

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Umoja, three days post-op, nursing.

Nyiramurema got up to find another shoot, leaving Umoja several feet away. He whined, turned over on his belly, and immediately crawled over to her dragging his broken leg. Though he whimpered the whole way, he covered the distance quickly. A few minutes later, he nursed for some time. Once I was away from the group, I called Magda and Elisabeth with the good news: Umoja was stronger, vocalizing and still nursing, and that the incision looked okay. On the following day, Magda’s photos showed an even brighter and stronger Umoja. He nursed at every opportunity. The swelling around the incision had decreased and the surface was dry.

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Kwitonda Group gorillas eating bamboo, Rwanda.

Elisabeth checked Umoja on the fourth day after surgery. He whimpered throughout her visit, but nursed well and appeared strong. When I returned on day five post-op, the trackers were all smiles. We found Kwitonda and his group eating bamboo shoots in a dark, vine-filled patch of forest, close to where they’d been foraging all week. The trackers believe—and I agree—that the silverbacks know not to move too far or too fast when a member of the group has a problem. (This is noticeable when there’s a newborn baby.) Kwitonda stopped eating briefly to glance sideways at me. We found Nyiramurema nearby, sitting upright with her back against a tree.

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Umoja, seven days post-op, (photo courtesy of our friend Louise Hurst who visited Kwitonda Group as a tourist.)

At first, I couldn’t see Umoja. He lay on his back on the ground behind his mother. As she had the other day, Nyiramurema got up to look for more food, walking calmly past me at a distance of about four meters. She moved up hill, doubling the distance between us, leaving Umoja behind and to my left. He stayed quiet for a few seconds, then began to crawl after her, using his elbows and left knee while holding his right leg off the ground—and whimpering loudly. Halfway there, he turned to look at me and started to scream. He screamed all the way until he climbed onto his mother’s back. She simply continued eating.

Jerome looked at me, smiling, and whispered, “They think you are the enemy, the doctor is the enemy.” But never mind—I’ll take that in exchange for a healed patient any day.

Umoja’s Case: Part 3

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Nyiramurema carrying Umoja the day before surgery.

Nyiramurema seemed to realize her mistake. She turned sharply and headed uphill before the trackers even got close. Still woozy from the anesthetic, she tried to run, limping as usual, and stumbling in the effort to carry her infant. It didn’t help that she’s blind in one eye. I followed her dark outline through the dense vegetation. She navigated several obstacles, holding onto Umoja, then fell on her belly. Umoja slipped off her back. He barely moved and made no sound. Nyiramurema didn’t even glance back at him as she rose; instead, she took off at a run. In a few seconds, she’d disappeared.

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Umoja nursing from Nyiramurema the day before surgery.

A wave of fear hit me. Healthy juvenile gorillas can find their way back to their mothers and family group if placed nearby, but this was a two-year old with a broken leg. If Nyiramurema rejoined the group without her infant, would she look for him later? If Kwitonda figured out that we’d intervened, he might move even faster uphill, away from the infant. Umoja needed his mother’s milk, body heat, and protection. The group might not find him in time. Or, he might be rejected.

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Nyiramurema moving through dense bamboo.

I looked at the trackers, raising my eyebrows in an effort to signal “Should we carry him to the mother?!” (They speak mostly Kinyarwanda.) I asked the same to Elisabeth in English. Nobody moved or said a word. For a moment, we were all at a loss. We could no longer hear Nyiramurema. I asked Magda what she thought. My instinct was to pick up Umoja and run uphill in the hope that we could still find his mother and set him down near her, ideally on a trail leading back to the group.

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Umoja covering his eyes, a sign of agitation and discomfort (the day before surgery.)

Magda agreed we should make the effort. Elisabeth nodded her head. I put my mask and gloves back on and picked Umoja up with my right arm under his buttocks, trying not to knock his broken leg or touch the surgery site, and my left under his left armpit. It didn’t feel right to be holding a wild gorilla so closely, but I didn’t see any other way. The infant barely reacted, raising his hands over his head. I began climbing, knowing I’d need help from one of the trackers soon. We needed to quickly get between the mother and the rest of the gorillas so that we could leave the infant in her path.

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Kwitonda Group trackers during the intervention to remove Magayane’s snare (see blog); Pierre is in the middle.

I ran out of strength after ten minutes. Umoja weighs only about 15 pounds, but I’m not used to carrying that weight up hill on uneven ground. I didn’t want to slip and fall, or run completely out of energy. The vet work might not be over. I asked again for help from the trackers. Pierre, the tallest and strongest of them took the infant from me. He carried Umoja carefully, and with ease. Elisabeth called back and forth on the radio, trying to find out from the trackers where we should be heading. Suddenly, we heard gorillas. We stopped, hoping to intercept Nyiramurema as she caught up with the group.

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Dr. Lucy Spelman tries to warm up Umoja without getting too close to him.

I took Umoja back from Pierre, thinking we should set the infant down in the vegetation near the gorilla group sooner rather than later. But our patient now felt cold, and his hair was damp. He had been relatively dry at the end of his surgery, but had since been carried through the wet forest on his mother’s back. If I put him down, the other gorillas ignored him, and the mother didn’t appear soon, he could become hypothermic. Sweating from the effort of having carried him uphill, I decided to sit with the infant in my lap, let my body heat warm him, and wait quietly, hoping Elisabeth and the trackers would soon confirm the mother’s location.

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Kigoma, one of two black backs in Kwitonda Group.

A few minutes later, I caught a glimpse of a gorilla in a tree to my left nearby. Magda and Elisabeth confirmed the group was very close. Umoja’s older sister Chiri was also nearby, a good sign. I hoped they couldn’t see me holding the infant. They would have every right to charge me. Umoja had begun to warm up and regain some strength, moving his arms a bit and opening his mouth. His broken leg trembled but he seemed amazingly calm otherwise.

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Nyiramurema eating bamboo shoots with Umoja lying on his back nearby, after medical intervention.

Seconds later, the vegetation crackled to my right. No matter which gorilla it was, I was in a dangerous position with Umoja in my arms. We thought it could be the mother. I put the infant on the ground in a pile of recently eaten bamboo shoots. He rolled downhill a bit, and we all backpedaled. Seconds later, Nyiramurema appeared. She paused only briefly, picking Umoja up matter-of-factly, as if she’d expected to find him there and went on her way. Twenty minutes later, we watched her eating bamboo with the main group, the infant at her side and Chiri once again nearby.

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Umoja’s mother, Nyiramurema.

The infant lowland gorilla at the National Zoo whose wound I’d repaired grew up with no recognition of me as a bad person. His mother, however, has never forgotten. Every time I’ve gone back to visit, she regards me with what I would characterize as a glare. Nyiramurema never saw the dart, and never saw me holding her infant, but will she know me or Magda? We’ll find out soon enough. One of us will check on Umoja every day until he’s out of danger. We’re crossing our fingers that he’ll live long enough to learn to recognize his doctors.

Umoja’s Case: Part 2

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Nyiramurema and others groom Umoja.

We gave up 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.

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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.

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Umoja anesthetized, 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 thirty feet away, listening for the rest of the group, ready to chase them away if necessary.

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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 in right in on the surgery. On Umoja’s right side, she found not one but two gorilla 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.

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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.

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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 become infected or necrotic, he could lose his hand.

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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.

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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…

Umoja’s Case: Part 1

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Two-year-old Umoja hiding in the vegetation, 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 two-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.

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Silverback mountain gorilla, Kwitonda.

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.

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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 years ago, probably from a snare, and had all but stopped carrying Umoja in recent months. He’d grown too big. His older sister, Chiri, carried him instead.

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Umoja clinging his mother, Nyiramurema, 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 DC. 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 ribcage, his intestines had not been damaged. We closed the wound surgically, and he lived.

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Umoja’s mother, Nyiramurema, in Kwitonda Group.

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 into 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.

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Umoja injured.

We hiked about forty 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.

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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.

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Injured infant mountain gorilla, Umoja, nursing.

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.

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Umoja, two days after the fight with his mother, Nyrimurema, in Kwitonda Group.

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…