Ifeoma OzodiegwuBrazzaville!!!!I can’t believe I am finally here! After weeks and months of applications and planning and finally a twenty-two hour journey from Johnson City in Tennessee, I have arrived and I am ready to do some public health. Driving into town from the airport, the driver with the World Health Organization, the Organization  with whom I would be working with during my  three  month stay, showed some of the remarkable places in town.  He pointed out the President’s residence, the ministry of defense and biggest market in the area known as Marche Makelekele. “Marche” means market in French which is the widely used language in Congo Brazzaville. I completed a  three month intensive course in French about four years ago and as a result I am able to understand the language. However, I have difficulty speaking because I have been out of practice for those four years. Right across from Brazzaville was Kinshasa. The two capital cities are separated by a huge river known as Djoue. Congo Brazzaville is a small country located in Central Africa. It houses the African Regional Office of the World Health Organization (WHO).  This is my internship affiliate organization.

My duties as an intern involves, primarily, monitoring and evaluation of country compliance to the Framework Convention on Tobacco Control (FCTC) as well as production of tobacco control country report cards. The WHO FCTC is the first negotiated treaty under the auspices of the WHO and a regulatory strategy to address additive substances. It focuses on cutting off the demand and supply of tobacco products within countries. However, apart from the above mentioned duties, I also get to do rotations in other departments in order to get a well-rounded field experience.

Having arrived on a weekend, I had the opportunity to rest and recharge my batteries in order to be ready for my first week as an intern. On Monday morning, I was at the office bright and early. I got introduced to my supervisor, Dr Nivo Ramanandraiben and my preceptor, Dr Ahmed E. Ogwell Ouma. My preceptor is the Regional Advisor on Tobacco Control. I also met other members of the Tobacco Control Team. I was briefed on my duties and by Tuesday, I set to work by trying to understand and extract the information in the FCTC Parties Reports. Countries that have acceded to, ratified and agreed to implement the articles of the FCTC are known as Parties. The agreement to implement these articles is known as entry into force.  These Parties are expected to produce implementation reports two years and five years after entry into force. In the African region, 41 out of the 46 countries in the region have entered into force. Each Party report is 47 pages long and that would be keeping me busy for the next two weeks.

I am very fortunate to be given an opportunity to intern with the Tobacco Control Unit of the WHO for the next twelve weeks and want to thank Hope Through Healing Hands and the Niswonger Foundation for their scholarship support.   I will keep everyone “posted” so be on the lookout for my next blog report.  In the meantime, here is where you can find me.  

 

We are excited to share this update from our friends at Seed. We can't wait to hear about the great things that come from this class of volunteers!

We are thrilled to announce the new class of Global Health Service Partnership Volunteers has arrived in Washington DC for orientation. This class of 42 volunteers is made up of a remarkable group of US physicians and nurses. They come from 22 states from around the US, range in age from their late twenties to late sixties, represent myriad specialties including obstetrics and gynecology, anesthesia, surgery, and mental health, and seven are returned Peace Corps Volunteers eager to apply their clinical experience in service. They are made up of 19 physicians and 23 nurses who will return to our partner sites in Malawi, Tanzania and Uganda. We are proud that three are first year GHSP volunteers who have decided to continue for a second year. 
 
These 42 volunteers will build on our extraordinary first year. We just returned from our Close of Service conference and were thrilled by the impact our first class had. Volunteers reported improving education, patient care and making a lasting impact on their professions. A few stories:
 
Matt Robinson, a physician volunteer in northern Uganda, shared how on his departure he was told by the head of his department that the mortality rate drastically reduced after his co-volunteer and he started. Further, they impacted retention. Most students do not choose generally to stay in government hospitals to work. This year, Matt overheard five graduating students ask if they could be taken up as interns at the hospital. Before, people only stayed because it was required. Now, they stay because they are choosing to. 
 
Kelly Lippi, a nurse volunteer, worked at the Mbarara University of Science and Technology in southwest Uganda in the Bachelor's of Nursing program. Of her 150 students, less than two had chosen nursing as their profession. Most students wanted to go into medicine, veterinary medicine, or pharmacy. Nursing was a last choice, but none of these nurses knew what being a nurse could be. Kelly was determined to show them this. Every day, she would come with stories about how nurses could change lives and make a difference. At the end of her year, she asked for evaluations. One student wrote "you have made me feel that I have chosen the best profession in the world." The student further elaborated she was excited to share this with her future students. Kelly achieved her goal.
 
Maureen Ries, a obstetrician working in northern Tanzania, held a conference for the labor nurses at her hospital. She taught 45 new nurses skills and protocols to make them feel more comfortable about the tasks about which they were responsible. After the conference, Maureen was presenting to her fellow physicians and was asked if all the nurses in the rural communities had attended Maureen's conference too. Maureen learned that the 45 nurses had all spread the updates Maureen had taught to the outside communities and the nurses were now updating the doctors there. Maureen provided essential education for the hospital staff, but its impact was far larger. 
 
We are excited to see this same energy and impact build over this next year. None of this success is possible without your support. We thank you for your commitment to Seed's mission of building sustainable workforces and welcome you to continue this journey with us. 
 
Vanessa and the Seed team

We arrived on the pediatrics ward this Monday, a little less naive and much less shell-shocked. I had grown accustomed to hearing only the whirring of ceiling fans, barking dogs, and the quiet chatter of Sinhalese in place of the traditional mind-numbing beeps and alarms of our medical equipment. I was pleased to see protective screening over the open air hallways, to keep the children from tumbling two stories, and to keep out the birds. It was surprising to see the number of children waiting to be evaluated for possible admission. Nearly all the beds were full, and it seemed as though they were in the habit of converting previous storage closets, consultant lounges, and any available space into treatment areas. The need for even more space remains evident.

We were greeted by Dr. Jayantha, the department head, and were quickly incorporated into rounds. My incredible learning experience began the moment we arrived at the first patient. Rapid fire questions regarding minute details about pneumonia. "Inspect this X-ray, what do you see? What organisms cause the X-ray to appear this way? How do you know? Are you certain? Why is this child's pneumonia not caused by Klebsiella?" As the only visiting students on the ward, we were not spared! He is a fantastic educator and we were soaking in every piece of information. The ward was full of interesting cases. Kawasaki disease, meningitis, dengue fever, juvenile rheumatoid arthritis, osteogenesis imperfecta, just to name a few. About 25% of our patients that day were hospitalized due to new occurrences or relapses of nephrotic syndrome. Dr. Jayantha explained the incidence is very high here, mostly caused by minimal change in his younger patients. He calls them his "nephrotics" and he holds a special renal clinic for these patients every Wednesday morning, which we attended. Collectively, we saw nearly 50 patients that Wednesday morning with some variation of this syndrome. He has spearheaded a study on his nephrotics over the past 15 years. It will certainly be an interesting read once his results are published.

Regretfully, Friday was our last day on the Peds ward. We were benefited from phenomenal teaching by a handful of consultants who were intent on actively involving their students during rounds. "Palpate this child's skull, Holly. What do you find?" "An open fontanelle sir," I responded. "Quickly, in your notebook, write down 3 reasons you may find an open fontanelle in children over the age of 18 months" he demanded. Apparently noting the oppressive heat in the ward, and the obvious sweat forming on my face, he continued, "Quickly, and then we will go snowboarding!" Snowboarding? "I'll take it," I said. "Too slow," was his response. Then he erupted in laughter, gave me a pat on the back and moved on to the next patient. This kind of rousing I was familiar with!                                     

The opportunity to go into the community and provide antenatal care, well child checks, and give immunizations was extended to us by Dr. de Silva in the Department of Community Health. We had been waiting for this! We boarded the bus with 20 medical students from the University of Ruhuna Faculty of Medicine and set out towards a primarily Muslim clinic in Gintota, about 10km from Galle. 10km came and went, then 20km, maybe 30km. There was much discussion between the bus driver, the spotter, and the instructor in charge of this outing. I didn't need to speak Sinhalese to understand that we were lost! When we finally made it to the road leading to the clinic, the bus was unable to fit, so we walked the final 2km. We walked through tiny villages, past small shops, and many people who hadn't seen many (or any) fair skinned, light haired women walk past their homes. They were curious, and came off of their porches to watch where our journey would end. It ended at a clinic at the top of a hill, which was closed! A cyclone had badly damaged the structure three weeks prior. We now had to make the trek back down the hill, into the Muslim town, where we were shuttled by a community doctor to the temporary location at a school. 35 moms-to-be and 35 children were seen that day. Although cramped in their temporary clinic, their system worked well.

We visited a Sinhalese clinic a different day this week, which strictly provided antenatal care. We found this to be just as efficiently run, with roughly 60 mothers receiving exams. I was amazed at how integral a role the midwife plays in prenatal care in the villages. She performs all exams, including albumin and blood sugar checks, fundal height measurements, and even listens for fetal heart sounds through a pinard stethoscope! A "pinard" is a cone shaped instrument made of wood, plastic or aluminum, with a second cone at the top through which you are to listen. The fundus and the baby's head are palpated, pressure is placed at the top of the fundus, and the pinard is placed approximately over the baby's left shoulder. The provider then places their ear on the top side of the pinard and listens closely (very closely) for fetal heart sounds. Warning: The aforementioned technique may read as an easy procedure; however, after being spoiled by dopplers and fetal ultrasound, this takes much practice and a well trained ear!

I read somewhere that Sri Lanka has been called the "gem" of the Indian Ocean. It is most definitely unique. The people, the food, the language, the landscape, the culture, all novelties to me. Every day is an adventure here, and I am cherishing every one.

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The Girl Effect info graphic

I wasn’t sure what to expect when I arrived at Mahamodara Maternity Hospital. The tuk tuk dropped us off outside of what appeared to be fortress walls. We were met by our Duke coordinator and led through the gate, past a building that was in disrepair and dilapidated. We traversed through a labyrinth of crumbling plaster and boarded up windows. There was a smell of mildew lingering in the air. I thought to myself, “Women come here to give birth”? Once we rounded a corner, I noticed an area to my right which looked as if it should have been full of expectant women, but was eerily vacant. It was then I realized what I was seeing was the shell of the Mahamodara which stood during the 2004 tsunami. I stared into the ward, and could imagine this area full of pregnant women and newborns on that day, and could almost feel their terror. I was told the hospital was hit by 3 waves. The first wave destroyed the “fortress” walls that I had seen earlier, but these barriers had lessened the impact to the building. It flooded the first level and knocked out the electricity. The doctors and staff evacuated the mothers and infants, some to higher ground, and others to Karapitiya Hospital. The second wave was estimated between 20-30 feet high. There are many stories of heroic men and women from that day, including one physician who calmly completed a Cesarean section by flashlight after the first wave hit. He then safely evacuated the mother and child. Due to lack of funds to demolish the building, it now stands as a temporary memorial.

We moved on, and at the end of the hallway we entered a courtyard. In front of us was a beautiful new building which now housed high risk expectant mothers. The ward contained 64 mothers who had a variety of problems, such as gestational diabetes, hypertension, and preterm premature rupture of membranes. There were strict visiting hours here, so there were no hovering families or concerned husbands. The hospital has very few fetal heart rate monitors, so the midwives and nurses monitor the fetus through the use of a pinard.  I spent a lot of time in this ward, and in the antenatal clinic, examining patients. I practiced with the pinard, straining to hear the fetal heartbeat as clearly as these experienced midwives, who could easily estimate fetal heart rates. I did many abdominal examinations, measuring the fundus, palpating the fetal position, and attempting to guess the baby’s weight in kilograms. I was certainly attaining one goal I had for this rotation, to get back to basics!

I witnessed the miracle of birth for the first time this week. I made my way through the maze of exterior hallways at Mahamodara to the labor and delivery room. Once I entered, I saw 10 wrought iron beds sitting side by side, each containing a woman in varying stages of labor. Two had just given birth and were coddling their newborns, encouraging them to breast feed for the first time. Several were in the final stages of labor. I chose a mother and joined the midwife and medical student who were at her side. I again noted the palpable absence of the typical “cheering squad” you see in America. These women were left to hold their own legs, and labor alone. There are no epidurals or pain medication, just pure will and true grit. After another hour of exhausting effort, she gave birth to a healthy baby girl. A new mother’s joy transcends all language barriers!

This was my final week in Sri Lanka. I cannot express enough gratitude to the doctors and staff at Karapitiya Hospital, and the University of Ruhuna Faculty of Medicine, for all of their time and willingness to share their vast knowledge.  The long journey home gave me time to reflect on my experiences here, and all that I have learned. Of course I am extremely grateful to have had the opportunities to assist in surgeries and delivering babies, to learn about rare illnesses not seen in the United States, and to practice primitive examination skills; but some of the most invaluable lessons I have learned were from the Sri Lankan people themselves. They are a hopeful people. Having recently suffered through a natural disaster, as well as a three-decade long civil war, they see brighter days ahead and are working hard to be sure the whole world can see them too. They are patient people, accepting of the fact they may have to return to the hospital daily in hopes of being admitted, or that their surgery may be delayed by many weeks. They are people who are full of grace, willing to undergo painful procedures without pain medication or anesthesia, with no complaints. Finally, they are a grateful people. They understand they are fortunate to have free healthcare and very skilled physicians. The phrase “medical malpractice” is foreign to them, and litigation against their physicians is unheard of. They are grateful for visitors from faraway lands and are eager to share their history and culture with all those who are willing to make the trip!

January 13

I can’t believe my time here in Haiti is over—but it is. I’m writing this from my guesthouse in Port-au-Prince, in preparation for my flight home tomorrow.

I would like to thank Senator Frist for forming the Frist Global Health Leadership Program, and for allowing me to have come to Haiti to work at HIC. I’d also like to thank the many people at Vanderbilt, Dartmouth, and HIC who helped me make the needed connections and organize the details of my trip. Last but not least, I’d like to give a special shout-out to my boyfriend, for supporting and encouraging me to leave him—and the U.S.—for three months and go work in Haiti. Thank you.

Although there were certainly nights that were incredibly difficult, there were many more that were amazing, and I am so very thankful for having been able to work at HIC. I was able to learn from so many experienced, kind, patient doctors and (mainly) nurses. They opened their hospital and the maternity ward to me, and were willing to teach me and make me an infinitely better midwife. I know that my time at HIC will forever impact how I care for my patients, and how I look upon all of the resources available to my moms and babies back in the U.S. Additionally, working here has further solidified my desire to work internationally, and has given me a clearer idea of what that life will be like.

I sincerely hope that if Senator Frist had come to visit HIC that the staff and the patients I interacted with would have said I was worthy of being a Frist Leader.

This last picture is of me and an auxiliary nurse (kind of like an LPN) named Mrs. Lorcey. Mrs. Lorcey works most nights, and so I worked with her more than any other provider during my time at HIC. I was always pleased when I'd arrive to work and see Mrs. Lorcey there because we worked well together and respected each others skills as providers. Although at first Mrs. Lorcey didn't trust me--as she shouldn't have--as I slowly proved myself and my skills she let me do more and more on my own, and helped guide me through interventions that I'd never done/seen before. By the end of my time at HIC I know that she believed in my abilities, and let me work as independently as I wanted. I worked with Mrs. Lorcey on my last night at the maternity and in the morning when it was time to leave she gave me a big hug--something I didn't see that often in Haiti--and told me she'd miss me. I will certainly miss her,  her smile and her quiet, calm encouragement when I was stressed or unsure of what I was doing.

 

 

Senator Frist's new USAID video on family planning—the healthy timing and spacing of pregnancy—is a great, concise explanation of the problems centered around maternal mortality and what we can do to help, because we know it works. Take 1 minute and 52 seconds to watch it. It'll be worth your time.

I’ve been home from Rwanda and Kenya only a few days and I’m already on another flight, heading back to Aspen, this time for the Aspen Ideas Festival Spotlight: Health, co-sponsored by the Robert Wood Johnson Foundation.

It’s on flights that I have time to reflect on a few takeaways, drawn from the myriad impressions and experiences I gathered in Rwanda. I tell everyone that journeys to Africa are life-changing and indeed this one was for me, and hopefully those who joined me.

  • Partners in Health—that unique Boston-based nonprofit global health organization—is uniquely positioned in Rwanda to develop research-based health service models that can be applied around the world. In fact, we in the States have much to learn from these. It’s well on its way to doing innovative, PROVEN programs of science-based health delivery; creating disciplined training programs; and even taking aggressive cancer therapy to the rural poor in a way that is economical and effective.
  • Paul Farmer should get the Nobel Prize. He has demonstrated in Haiti and Rwanda and around the worldthat health care can be brought to the people who need it. He has shown the world that therapy once regarded as too expensive to buy and deliver—like HIV treatment—can be effectively and inexpensively administered to the poor and rural. And now he is addressing cancer treatment in rural Rwanda.
  • Gorilla health is like human health. My work with the gorilla health began at the National Zoo in Washington. Some mornings I would scrub in at 6 am over in Rock Creek Park to take care of a sick gorilla before opening the Senate as Majority Leader. My interest in gorilla health continues, and that is why I introduced our group at the base of the Virunga Mountains to the vets with the Mountain Gorilla Veterinary Project, on whose board I served for years. The upland gorilla, whose march toward extinction was reversed by Dian Fossey, has grown in number from 750 to 880 just over the years I have been involved. Animal conservation working hand in hand with animal health makes a difference. As an aside, I want to raise a red flag to the rapidly growing problem throughout Africa of elephants being massacred for ivory.
  • ONE health is a concept and a movement I hope others come to understand. It gives name to my conviction of focusing time and energies on human health, animal health, and environmental health. Health and healing applies to all—in Rwanda to the land around us, the farmers, the cows and buffalo, all interacting integrally with each other, as so clearly manifested at the base of the Virunga Mountains. Living side by side with mutual respect for each is the only answer. Gorillas are extremely susceptible to human-borne illness. Crowding brings buffalo in close contact with the gorillas, contaminating waterholes and leading to disease and death. Too many people still rely on bush meat for food, killing gorilla and monkeys. Gorillas are also threatened by hunters trying to trap antelopes for holidays and celebrations, unintentionally ensnaring baby gorillas. Health for one is health for all.
  • The HRH program in Kigali blew me away. It will work and I predict become the model of the future where governments are not corrupt. It is built around partnerships. Twenty-six US universities partner with USAID, the source of $33 million, to deliver and improve health services in Rwanda. The process through which the money flows goes like this: the American taxpayer gives his money to USAID who channels the money to government of Rwanda led by Paul Kagame who channels the money through the highly respected Minister of Health Dr. Agnes Binagwaho. Dr. Binagwaho distributes the money to the sites; 86 health professionals on the ground lead large programs to improve health service delivery. An orthopedic surgeon from the Brigham in Boston or a hospital administrator from Yale may then come to introduce systems to the Rwandan hospitals and district pharmaceutical distribution center. Over an eight year period, the goal is to train Rwandan workers with the skills and knowledge to build and sustain their own programs over years to come. It is working and it is a wise and smart use of the taxpayers’ dollars.
  • Paul Kagame is the man for the times. He has courageously taken a country that in 1994 was deeply divided by genocide, which claimed the lives of 20% of the population, and deeply divided by artificial colonial convictions, and though strong leadership has reconciled the people, formally achieving forgiveness in the immediate aftermath of neighbor-killing-neighbor, and establishing and maintaining remarkable peace. At the same time his belief in markets and investment has led to 29 years of annualized growth of 8% and is greatly expanding the middle class. His leadership is dramatic. He leads from above but implementation begins at the village level. When the president says thatched grass roofs lead to poor health and suggests replacement, it is each neighborhood that comes together every Friday over a two year period to assist in replacing the grass roofs with metal ones. When it is identified that wearing no shoes, the African custom, allows parasites to enter the body leading to disability and death, a proclamation from above to wear shoes was implemented at the community level almost immediately. The New York Times and New Yorker don’t like him, but I think he is an amazing man who has saved his country of 11 million people.
  • Journeys to Africa by Americans are a good thing. Our group of 10, half of whom had not been to Africa, bonded and shared our own perspectives in a close, personal, and intimate way. Africa touches one’s heart. It inspires. It cause one to dream. It changes your life.
  • Health care is improving fast in Rwanda. Vaccinations far surpass those in the US. Childhood mortality has been cut by 2/3. The basic district health clinics are accessible to all and they place a heavy emphasis on family planning, healthy pregnancies, and early childhood health and nutritionMaternal, newborn, and child health are the foundations of strong communities. The fledgling national health insurance system is solid and growing fast and has been received well. The system gets by with MRIs and CT scanners. It has only one urologist in the country and five pathologists. Heart surgery is rarely done. But all that will change as the economy improves. The new cancer center at Butero, established at the district hospital as a brainchild of Paul Farmer and the Ministry of Health, will greatly expand cancer therapy the county, heretofore lost in all of the attention on infectious or communicable diseases like HIV, malaria, and tuberculosis.
  • On my return journey, I stopped in Nairobi, Kenya. Crime in Nairobi is high—street crime and home invasions with burglary and carjacking. Al-Shabaab, the al-Qaeda-affiliated Somali terrorist group, is increasingly threatening the city. Tourists are not coming and hotel census is down. Corruption rules the government and police, it seems. But commerce continues and I spent a day in a wonderful market and had top notch service at the Tribe Hotel, where Jonathan, my son, introduced me to the wonderful family who has developed it.

January 5

Happy New Year!

Apart from working at the maternity this week—and getting to celebrate the arrival of 2013 with laboring women and their new babies—I’ve been busy completing the list of HIV+ women who have been lost to follow-up.  From March of 2009 until November of 2012 there were 240 women who started receiving HIV care at HIC, but now no longer are doing so. I really hope that the social worker and the community health workers will make use of this list and that some of them will be found and restarted with their HIV care. I am however, not incredibly optimistic that many women will be located. The social worker and community health workers are already very busy and to try to track down 240 women—with little more than their names, dates of birth, and possible addresses—seems very ambitious. But I feel that if even one or two women are found and are restarted in care that my work on the list was worth it. 

Along with the lost to follow-up list I’ve also been working on an “opposite” list—collecting information about those women who are still receiving HIV care at HIC. The hope is that with both lists, providers at HIC will have a better sense of whether or not there are differences between those women who are lost to follow-up (LTF) and those who are active. Maybe it’s the timing of enrollment in the HIV program, or whether or not a woman gives birth at home or in the hospital, or her age that is a significant factor in whether or not she stays in care. With that information the providers at HIC may be able to modify certain aspects of their program (i.e. enrolling women earlier if that was shown to make a difference) or focus on certain “at risk” women (i.e. if older age is show to have increased LTF risk, providing more education/support to those in that age range), thus—hopefully—decreasing the programs LTF rate and ensuring more women (and their babies) receive the important HIV medication and care.

This week I also went into the capital and had the pleasure of meeting a woman who is running GHESKIO’s Nurse Practitioner program. (GHESKIO stands for the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections, and was the first institution in the world dedicated to the fight against HIV/AIDS. It has provided continuous free medical care in Haiti since 1982) I talked to her about what can be done to better define the role of an NP in Haiti—to distinguish NPs from the nurses and doctors, and to make sure that the doctors don’t worry about NPs “taking their jobs”. I also got to meet three women who have already graduated from GHESKIO’s NP program who are working as NPs at GHESKIO. All of the women that I met were amazing. They were all very motivated and open to improving the NP program and striving to provide the best care they possibly can for their patients. 

 

*I’m in Rwanda this week representing Hope Through Healing Hands with Dr. Paul Farmer, Partners in Health Rwanda, and Harvard Medical School. These dispatches from the road are my personal journal–recording what I’ve seen and learned on this trip. See my pre-trip thoughts, and blogs from MondayTuesday, and Wednesday

Today we went to see some of Rwanda’s natural treasures: mountain gorillas.

Rwanda has a long history of gorilla conservation. Dian Fossey, author of Gorillas in the Mist, founded the Karisoke Research Center in Rwanda in 1967 and studied gorillas in the Virunga Volcanoes until her death in 1985.

We were hosted by Gorilla Doctors, a mountain gorilla veterinary project supported by the UC Davis Wildlife Health Center and dedicated to saving the mountain gorilla species one gorilla patient at a time. Gorilla Doctors serve the mountain gorillas throughout the Virunga Volcano Mountain Range that spans Uganda, Rwanda, and the Democratic Republic of Congo (DRC).

With Gorilla Doctor guides, we spent six rainy hours trekking through Volcanoes National Park looking for the Titus family of 10 gorillas—including one silverback and one 3 month old newborn. We finally caught up with them at about 9,000 feet.

photo 1 (16)

These incredible creatures are monogamous vegetarians. Each mother has 4-5 children during her lifetime, starting when she’s about eight years old. They can live to be 43 years.

At one point, the gorilla population here was down to 250 animals. When I visited in 2008, there were 750. Today, Gorilla Doctors estimates that there are 880 gorillas.

But gorillas are not quite the departure from human health that they may seem.

Dr. Jan Ramer, regional manager of the Mountain Gorilla Veterinary Project, explained that Gorilla Doctors approach their work from the “one health” perspective, a belief that the health of one species is inextricably linked to that of its entire ecosystem, including humans and other animal species.

photo 3 (9)

It’s easy to see how closely the species connect.

The number one killer of gorillas is trauma. On our walk we came across three rope and wire snares. Though meant for antelope, gorillas, especially infants and juveniles, sometimes get caught in these snares. Gorillas may lose limbs or digits to snares, or die as a result of infection or strangulation. Gorilla Doctors respond to reports of gorillas in snares and work to treat their wounds and release them.

The number two killer of gorillas is infectious diseases, and humans and gorillas are susceptible to the same diseases. In fact, the most common infection in gorillas is respiratory disease, which can range from a mild cold to severe pneumonia, in individuals or in whole groups. These diseases are often passed from human to gorilla.

I’ve worked with these animals before, even doing some gorilla surgery, but seeing them in their homes never gets old. Amazing creatures.

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