A Memorable Patient - An Earthwatch Expedition

Elspeth Pitt, an Earthwatch volunteer tells an unusual story of her experience on the Madagascar Lemur project

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Expeditions to Madagascar

 

I think everyone would agree that going on an Earthwatch Expedition is a memorable and worthwhile way to spend ones free time. Last October, during the Team 1 visit to Madagascar's Ranomafana National Park for the Madagascar's Lemurs trip we had an unexpected and unique experience that none of us (not even the Principal Investigator) had anticipated.

The Ranomafana National Park Project was set up in 1991 and now has four main components to its work: conservation and research, community based sustainable development, education and a health programme. We were privileged to assist Dr Pat Wright and the very enthusiastic and experienced team of research guides at the park in a long term study looking at the behaviour and ecology of the Propithecus diadema edwardsi lemur. This study has been ongoing for 14 years and involves research on four groups of the Propithecus that have been habituated in the park that Dr Wright helped to set up. We also had the opportunity to see a number of other species of Lemur as well as many other animals, plants and birds on our numerous walks in the rainforest.

As I am sure is often the case we all got quite involved in whichever of the four groups of Propithecus we were observing. We would even get quite attached to the individuals, worrying when one of the young males went missing (it was not long until mating season) for a few hours or days. What none of us anticipated was how we could get so involved in the welfare of one of these gentle creatures to the degree we did following an event during the second week of our stay.

We were out on our usual patch in the rainforest taking notes on group 1 when one of the research guides came running up the path with a hand-written note from Dr Wright. The note appeared to ask that two of our team get back to the research station immediately.

We learned that a Propithecus (not one from the groups) had been found injured in one of the buffer zone villages and he was not in a good way. He had probably been involved in a fight with another lemur in his group and we surmised that he had been thrown out/deposed from his group. As Dr Wright explained, normally an injured wild animal is left to its own devices (after all, that is the way of nature), but the villagers had specifically come to Dr Wright for help. In the past they may have eaten the animal but over the years as the National Park Project had managed to educate the people for the need for conservation and they had come to realise how precious these animals are. It would have been very difficult to refuse their request.

We got to the village to find the lemur in a very weak but determined state clinging onto the roof of a shelter. He had apparently been there for at least four hours with no food or water. Richard, one of the research assistants, had a blow gun and a sedative/anaesthetic which we used in an effort to calm him and capture him without upsetting him too much. The first two darts had no effect, in the third we doubled the dose but still to no avail. The lemur was completely unconcerned by the darts and they had no effect whatsoever on his conscious level. We thought we would need even more of the drug however Kevin, being a professional animal handler at the Isle of Wight Zoo, managed to net him without any difficulty, the lemur was quite docile. In retrospect, I think that the animal was in such a shocked, dehydrated state that it could not absorb the intramuscular injection of the sedative from its muscle into its bloodstream.

Once we got back to the research station word had got around and we were met by a number of concerned onlookers, the research assistants, the American Study Abroad students, as well as the rest of the Earthwatch team. At this point I got a bit concerned at my potential role in these events. My conversation with Dr Wright went something like this: "I am a doctor not a vet ? I am not licensed to treat animals." (Although vets, I believe, can treat humans!) "Yes, but you are a surgeon - the nearest vet is at least two days away if he is at all on the island. You are the lemur's best chance." (Actually I am an Emergency doctor with a surgical qualification.) At this point someone reassuringly stated that if I screwed up they would take the lemur to the U.S. and have me sued!  I concluded that as lemurs are primates and only a few chromosomes different to us I would just have to imagine that I was treating a six month old baby and it might not seem so strange.

So we got Murdo, as he came to be known, indoors and I started the assessment: "Airway, clear. Breathing? Respiratory rate rapid, air entry equal, chest movements equal. Circulation,  pulse 160, no haemorrhaging wounds. Disability? Responding to painful stimuli, left pupil reactive to light, right not visible due to local trauma. Exposure, obvious wound to left side of abdomen."

Resuscitation was ongoing, he was clearly shocked, I couldn't get a drip into his veins (too small) so I gave him a small bolus injection of fluid and we sprayed him with cool water. We only had limited resources, we were only on holiday in the rainforest of Madagascar, not at work in the A & E department of a hospital!

Onto secondary survey: "He has a penetrating injury to the right eye, visual acuity is hard to ascertain. He has a big laceration in the front of his mouth and a fractured right upper canine. There is an incised wound to his left flank, abdomen is soft, bowel sounds quiet but present. There is a closed transverse fracture of the right ring finger and possible fractures of the little finger and right hand. He also has numerous small incised superficial wounds to his legs and arms."

Gratifyingly his pulse came down to 132 and his respiratory rate and level of consciousness were also improving with the external cooling and intravenous fluid (we only had 500mls of Dextrose/Saline but it was helping). He even became alert enough to take fluids orally (this is unusual for this species who normally get all the fluid they need from their food, indicating how dehydrated and sick he was). I then proceeded to explore, clean and stitch his flank wound, which on examination did not penetrate through the abdominal wall. Finally we took some baseline observations - weight, height, canine length and number of teeth as well as testicular size!

At this stage as Murdo began to recover from the sedative and we had to make arrangements for his accommodation. So whilst Kevin, Richard and I finished treating him the other members of the group were industriously trying to construct a cage from any materials they could find near the station. Hence the "Hilton Propithecus" was designed and constructed successfully, yet another truly team effort.

We were unsure at this stage if Murdo would survive his severe injuries or the stress of captivity and we all felt quite concerned for his well being. For the rest of the day he was constantly nursed by very caring attendants from the Study Abroad Group, Earthwatch and finally, of course, Dr Wright who kept him warm in her own tent overnight. The next morning Murdo was moved into his new home which was complete with branches for sitting on and clinging to and all the best leaves for eating. Lemurs are known to be quick to recover from illness and injury but do not do well in captivity and are notoriously fussy eaters. Murdo was not impressed with his new abode and just sat on the floor not even looking at the food or climbing onto the branches, he was still very weak and sick.

As he was neither eating nor taking the water we placed on the leaves, we constructed a rig from the drip set and bag of dextrose/saline that we had. We set it up so that we could hold the end of the drip close to his mouth in the cage and open the drip outside the cage. He lapped up the water from this delivery system even getting enough courage to hold our hand steady if we got too shaky for him. Shortly after we found him some tasty robary fruits (their favourite) and offered him these. He wouldn't take them unless we crushed each fruit and held them up individually to his mouth. What he started doing, like he did with the water dispenser, was hold the feeder's thumb to steady their hand while he munched on a fruit in their palm. Propithecus' hands are soft, like very soft leather, and even when he sucked on our fingers looking for fruit he was so gentle - I was surprised that the toothcomb and tongue were so smooth and soft.

Murdo's flank wound had completely healed in two days but he required hand feeding with the best and freshest fruits we could find in the forest on a very regular basis as he recuperated. By the fourth day he was beginning to take food off an offered branch and was starting to climb in his makeshift cage and his pule rate was down to 72.

After much discussion and consideration between the entire group including Dr Wright, the research assistants, the Earthwatchers, and the students we decided that it was best that Murdo was taken back to the area where he had been found.  Even if he was never taken back into his own group or if he was beaten up again by the lemur who attacked him, it was agreed that this was still the best option. It was quite an entourage that scrambled up the bare deforested hill into the rainforest to see him released. We found a suitable site and opened up the bag in which Tim had been carefully carrying him. To our complete surprise he just sat in his sack looking at us as if to say, "You feed and water me, smother me with attention and keep me safe and warm and you want me to leap out into this harsh forest where they beat me up!" Eventually, with some encouragement, he suddenly leaped into the trees and disappeared into the rainforest. He was followed for the rest of the day and he seemed contented. I have to confess that even I, the hardened A & E doctor, had a tear in my eye as he leaped back fit and well into the forest.

What did I learn from this unexpected and unusual patient? Well first of all, compared to most A & E patients who have been in a fight, he was much better behaved! Also the anatomy and physiology of our primate relatives is amazingly similar to ours (well at least similar to that of a six-month-old baby). The "ABC" principles of trauma care
(Airways - Breathing - Circulation) can be applied to primates as well as humans (after all they are only a few chromosomes away from us - maybe even closer in some cases!).

The whole experience was very much a team effort from the rescue, initial treatment, nursing care and cage construction, to the feeding and general care of Murdo. It was an amazing privilege to have handled, treated, cared for and even hand-fed this gentle and rare animal. We may even have been the first to document the resting pulse rate of a Milne-Edwards Sifaka - it is 72 beats per minute, similar to that of an adult human.

Further Information
If you would like to take part in an Earthwatch project, visit their website at www.earthwatch.org/europe 

Image courtesy insane photoholic