Gorilla Doctors

Dr. Eddy Kambale (hiding a syringe full of anesthetic in his left hand) is ready to start Ndakasi’s annual exam

Finally, it was time to give all three “Goma orphans” their annual exams. This would be Mapendo’s second exam under anesthesia and Ndeze and Ndakasi’s first. Fortunately, the gorillas had no idea what was about to happen. Ndakasi simply wanted to play with Eddy, not realizing he held a syringe in his left hand.

Anesthetizing the gorillas is, in many ways, more stressful for us. We know that their lives are in our hands. Even with the captive-living orphans, we try not to intervene with anesthesia. It helps that we can play with them a bit and see most of their body parts, but there are several things we cannot do without anesthesia, including collecting blood samples and administering TB tests. The results of these tests are essential for us to assess their health status. Additionally, all three orphans had long ago become moving targets when it came to trying to listen to their heart or lungs.

Ndakasi is just about to realize that Dr. Eddy is poking her in the rear end. When Eddy skillfully gave Ndakasi her anesthetic, she looked surprised for a few seconds, but quickly got over it.

We also needed to give each gorilla another round of vaccines while under anesthesia (their measles booster shots.) In recent weeks, we—Magda and Eddy—had already given the two mountain gorillas their tetanus and polio vaccines so that we could measure their immune response at the time of the exam. I also try not to vaccinate young animals with a bunch of vaccines at once as it’s harder for their immune systems to respond fully. Since they’d had a few surprise injections from people, we weren’t sure if they would figure out what was happening. Fortunately, they didn’t—at least, not until they felt the pinch of the needle!

Andre comforts Ndakasi after her injection of anesthetic, which she’s already forgotten about.

Andre picked up Ndakasi and played with her gently (in the photo she is “smiling” with her mouth open because he is tickling her) while she fell asleep under the effects of the drug. We use the same anesthesia for the captive gorillas as we do the free-ranging ones, a combination of a sedative, medetomidine, mixed in the same syringe with an anesthetic, ketamine. Not only is this a tiny volume, which helps when we need to use a dart, but there’s a reversal (antagonist) drug for the sedative which we give when we’re finished with the procedure. The effect is dramatic—within 15 minutes the animal is mostly back to normal, though they may feel a little groggy (i.e. hungover.).

Ndakasi is missing a number of deciduous (baby) teeth as a result of rambunctious play on hard ground.

Anesthesia is also the only way we can properly exam the gorilla’s mouths. Though they open them often enough while playing, a split second view isn’t enough. During Ndakasi’s exam we confirmed that she is missing three of her deciduous incisors. She and Ndakasi play hard, as do all infant mountain gorillas, but they’re also playing on hard ground instead of piles of soft vegetation and volcanic soil. Andre and the rest of the caretakers try to keep the orphans from climbing too high in the trees or from getting too rambunctious on the climbing structure but they do inevitably fall down. The games happen so fast that it’s impossible to catch them every time.

At rounds a few days later, we reviewed the dental eruption chart for great apes. Based on what is known in lowland gorillas, Ndakasi’s permanent incisors will not appear for several more years (she is just two-years-old and the first permanent incisor erupts at age five-and-a-half.) One thing is for sure, a few missing teeth won’t keep her from smiling during her play sessions.

Ndakasi is anesthetized during her annual exam with Drs. Jacques Iyanya, Eddy Kambale and Magdalena Braum.

The anesthetic combination we use gives us about 40 minutes to complete our exam, and although we can give a supplemental dose, we prefer to work in a team so we can do more than one thing at once and finish within this relatively short time frame. In the forest, we often need to keep the gorilla down longer, especially if the procedure is at all complicated. Plus, the logistics are more difficult. At least with the Goma orphans, we could work outside on a table with shelter in case it rained.

For Ndakasi’s exam, I monitored anesthesia (and took photos); Eddy did the TB test, collected blood with Jacques’ help, and then a set of routine measurements; Magda collected urine and a skin biopsy for genetic analysis. And we all had a chance to do a thorough physical exam.

We also had help from Sandy Jones who is the new orphan care manager hired by DFGFI (Diane Fossey Gorilla Fund International) to work in partnership with us (MGVP) on the day-to-day care of the orphans. These exams were a great opportunity for her to meet “the babies” up close—and she was immensely helpful in writing everything down. It’s amazing how many people it takes to examine, sample, and record data from a 15 kg gorilla in 30 minutes or less!

Simon Childs was the first to fill the orphan care manager position, and at the time, his job was a little different. There was no experienced team of caretakers, for one thing, or even a facility. For another, there were fewer orphans. Simon helped get everything started and also helped to raise several gorillas. Sandy joins us at a time when the caretaker routines are well-established and (knock on wood) we don’t have any new orphans, so she’ll be focused on the specific needs of the orphans—both in Kinigi, RW and Goma, RDC. For example, she’s putting together an enrichment program for them, and as of this set of exams, will also help make adjustments in milk amounts, forest food, and market food. I’m sure she’ll soon get involved in the plans for where they will live in the longer-term.

Originally from Great Britain, Sandy has worked with great apes in Cameroon, both Limbe Wildlife Center and CWAF. Not only has she hand-raised orphan apes, so she knows what it entails, she is very keen that they should live in natural social groups if at all possible. We’re all very pleased that she’s joined our team (and at some point I’ll post a photo of her without a mask!)

Ndakasi’s tonsils are prominent but not inflamed.

Among the three Goma orphans, Ndakasi is the youngest and we found that she also had the most prominent tonsils. Both she and Ndeze had also recently recovered from an upper respiratory tract infection—sneezing, coughing, fever—their first in many months. So this could explain their increased size, but it’s also normal for young gorillas (and children) to have prominent tonsils. These structures are like lymph nodes; they are part of the immune system. Among the Kinigi orphans, who are due for their next annual exams in a few more months, the two youngest, Dunia and Tumaini, also had prominent tonsils during their last exams. As in people, upper respiratory and pharyngeal (throat) infections cause this tissue to turn red. Pink is normal.

Ndakasi has just been given her reversal drug and will soon start moving; her right eyelid is swollen from her TB test.

As with any animal waking up from anesthesia, we do all what we can to minimize the stress so they don’t react by feeling scared or disoriented. In the forest, we pack up our kit as soon as possible and retreat, leaving only one vet and the group’s usual tracker to watch the recovery. In a captive situation, the orphans feel most comfortable with their caretakers. So as soon as we finished and gave the reversal drug to Ndakasi, we asked Andre to help her recover.

Andre helps Ndakasi recover, friends as always.

Aside from a swollen right eyelid from the TB test (it’s normal to swell right away, the test is one of delayed immunity and is read at 72 hours—they were all negative), one suture on her chest from the skin biopsy, and the shiny remnants of eye lubricant left on her face, Ndakasi was sitting up and acting normal within 30 minutes. It was time to move on to Ndeze.
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Now it’s Ndeze’s turn, and she has no idea.

Ndeze had been playing during the hour-and-a-half we’d been working on Ndakasi. She, too, had no idea what was about to happen. While Eddy was getting the anesthetic ready, I photographed her last play session for the morning. Ndeze’s dose would be only a little higher than Ndakasi’s. Though she is at least three months older, Ndeze now weighs only 1 kg more than her younger companion.

Magda is helping Ndeze to spin around on her back, a game this little gorilla loves.

One of the orphans’ favorite games is to be spun around on their back. Both Ndakasi and Ndeze (as shown in the photo with Magda) will throw themselves to the ground and stick up an arm or a leg, waiting to be twirled. Magda also helped fool Ndeze into thinking this day was just another one full of fun.

Eddy with Ndeze, waiting for her to fall asleep.

Eddy had to be the bad guy again and inject Ndeze by hand when she wasn’t looking. This is one of those situations were I’m particularly happy to be the mentor instead of the injector! We all have bonds with these gorillas, and Eddy works most closely with the two mountain gorilla orphans, while Jacques works with Mapendo. I watched both of them clench their teeth just at the moment he gave the injection. It’s not easy being mean.

On more than one occasion, I’ve relayed to them what I was taught by my mentors: sometimes you have to be “mean.” And this is one of them. If you’re not, and you don’t poke hard enough, or push the plunger on the syringe fast enough, the animal will jump away, and the drug will either be lost, not given, or only partly injected. Then we’ve all made more work and worry for ourselves. There’s nothing worse than a partial injection of anesthetic. You have to wait and see what happens before it’s safe to give more. And then, if the patient gets nervous or upset about having to get another injection, then the effect of the anesthetic can reduced. The same thing happens with darting, and it’s for this reason that I myself practice the afternoon or morning before the intervention and ask the other vets to do the same. It’s just not worth making a mistake that can be avoided.

Like Ndakasi, Ndeze was only momentarily surprised. She started to play but then began to feel sleepy. As her favorite blue ball toy rolled away from her, she could only look at it.

Ndeze still has a full set of deciduous (baby) teeth.

Unlike Ndakasi, Ndeze still has a full set of her deciduous teeth. She plays just as hard, so it’s not clear why she hasn’t lost or broken them, other than the fact that until recently she was definitely the stronger and bigger of the two. We often had the sense that Ndakasi was a little clumsy as well, and that this could be a result of the really tough time she had as an infant when she nearly died of pneumonia. Eddy plans to make a dental chart for each orphan so he can note when their permanent teeth come in.

The gorilla doctors give Ndeze her annual exam: Magda, Eddy, and Jacques.

We each had the same assignments for Ndeze’s exam, and found that she too was in good condition except that we all had the impression that her hair coat was a little rough. We’d already discussed with Sandy that she could help with the transition of the orphans to select vegetables and fruits purchased at market. We’d been hoping to keep them only on milk and forest food, but the deliveries of such have been intermittent. Though the road to Rumangabo where the trackers collect food for the orphans is now safe, it’s still quite a difference. If we’re right that they need a more varied diet, we expect to see their hair coats turn shinier.

Eddy and Jacques take measurements of Ndeze during anesthesia.

Alternatively, what these orphans may really need before they look the picture of health is to move out of Goma. This is, as I’ve mentioned before, something we’re planning for, but nothing is final yet. But PLEASE, if you want to help secure a future for the Goma as well as the Kinigi orphans, make a donation here, on the MGVP Web site, or the ICCN Web site. If you mark your donation as restricted for the orphans’ care, then that is what it will go to! If we can build up a fund for them, we will have more options.

For these two, Ndeze and Ndakasi, there’s virtually no way they can return to the wild, for several reasons. They were rescued too young; by the time they reach the age where they could survive on their own (at least three years from now), it’s not likely that their families—the gorillas that remain of the Rugendo (Ndeze) and Kabirizi (Ndakasi) groups—will remember them. Moreover, they will have lived so long with humans that, despite all our best efforts to keep them in quarantine, they will have been exposed to diseases in a way that would never happen to them in the wild. It would be a risk to put them back out there, not only for their own health and safety, but because it could put the existing healthy population of mountain gorillas at risk. Finally, they will be strongly imprinted on humans for years to come—at least until they can live with a family of their own. Even so, we’re determined to work with our partners to move them to a place that feels more like home.

Like Ndakasi, Ndeze woke up comfortably in the arms of Patrick, who closed his eyes during this photo, making him look as if he were about to go to sleep.

After making certain that both Ndeze and Ndakasi were well recovered, we moved on to Mapendo. Magda, Jacques, and I had discussed whether or not we should begin by trying to hand-inject Mapendo, or simply begin with a dart. Not that one is necessarily easier than the other, but she’d been hand-injected before by Magda. She’d never been darted. Magda felt she might remember her and we didn’t want to upset Mapendo. Jacques, however, had never been the bad guy. He was confident that he could give the injection and preferred to try.

Sure enough, it couldn’t have gone better. In fact, after watching all three orphans be hand-injected by their regular vets, I was extremely impressed at how well it worked. Once again, Jacques knew he had to be quick and firm. He sat on the edge of the bet and let Mapendo give him a hug, then when she turned away from him for a split second, he jabbed her.

Mapendo looked shocked when she felt the poke, though not much more so than Ndeze or Ndakasi. The caretakers laughed, and the gorilla came running over to me. But instead of showing any sort of aggression or anger, she simply wrapped her arms around my legs up and looked curiously up at me. I hadn’t seen Mapendo in months and didn’t think she’d remember me. She must have, or I don’t think she would have behaved so calmly. She also could easily have run to her caretakers for comfort. Indeed, after I didn’t reach down to pick her up (she’s too big for me, plus I had the camera, and I wouldn’t trust her not to bite) she looked to them for a hug.

Dr. Jacques Iyanya collecting a blood sample from the anesthetized Mapendo, with Sandy recording.

Since her arrival in Goma, Mapendo has been the picture of health. She’s had only a one-day bout of diarrhea and never any sign of respiratory illness. This is interesting and important, as it shows that a young gorilla with a healthy immune system that is kept in a clean, quarantined area, can indeed escape illness.

Mapendo lives in a small room and fenced in enclosure with only her caretakers coming and going. The tin wall is so high that no one can see over it. Ndeze and Ndakasi, by contrast, live in a house that is better in some ways because it has more room and a yard with trees, but it also is more exposed since the wall around it is not all that high. There are not supposed to be any visitors to either location. Unfortunately, we know this rule has been broken from time to time (though not by our staff) and it makes sense that the younger gorillas with the less-developed immune systems will eventually come down with respiratory illness. This is one reason it’s so difficult to plan for their long term care. Cleanliness and hygiene are crucial to the day-to-day health of the gorillas—as well as to our own. Proper care for the orphan gorillas is a 24-hour operation.

Mapendo’s teeth show no change from last year.

Mapendo has a full set of deciduous teeth as well, plus one permanent set—her first molars (the last tooth in the back on either side). She had these when we first examined her a year ago, and it was for this reason that we said at the time that she had to be at least three-and-a-half-years-old, or a little older. This makes her almost 5 now.

Jacques is collecting a blood sample from Mapendo while she is anesthetized using a “butterfly” needle placed in the femoral vein; the monitor reads Heart Rate 79 and Oxygen Saturation 100%; there’s also a thermometer in place, which read 98 degrees F.

In our lab in Musanze (Rwanda), we can run basic blood tests like a blood cell count and serum chemistry analysis, as well as a urinalysis, but we also arrange to export the samples for more testing.

Ultimately, a laboratory in the United States that runs tests for antibody levels to various organisms will analyze the orphans’ blood samples. This is how we know how well our vaccines are working in the case of the orphans; for wild gorillas, it’s how we learn what they may have been exposed to, since we don’t vaccinate them.

On the subject of vaccines, people often ask me why we don’t do so for the wild gorillas, given the risks presented by their proximity to humans. The reason is that we’d have to dart about 30 percent of the habituated gorillas on a routine basis—basically yearly because all new infants would need a series of shots. The babies are too small to dart so we’d have to anesthetize mothers, which would put perfectly healthy animals at risk. Though we’re prepared to vaccinate in the face of an outbreak of, say, measles or polio, we absolutely believe that our focus should be on prevention. Moreover, some diseases, like tuberculosis and the common cold, have no vaccine. This is why I often sound like a broken record: only healthy people should visit gorillas. A cough means you’re sick!

Mapendo woke up from her anesthesia with Babo just as quietly as she had gone asleep.

Overall Mapendo was in excellent health, and, once again, a little overweight. In her case, the problem isn’t exercise in that she’s constantly on the move playing with the caretakers and on her climbing structures and ropes. We think she’s simply getting too much “market food”—especially bananas. Sandy plans to visit again soon and help make some adjustments to her diet, while also start Ndeze and Ndakasi on market food.

While we continue to work out the future for the orphans, the good news is that they’re all healthy, and they have an excellent set of caretakers.