Doctor's Diary, Part VIII: A Visit With Gorillas

Dr. Bill Frist, the former U.S. Senate majority leader, is an accomplished heart and lung transplant surgeon who trained at Stanford University and was among those who pioneered heart transplants. A Tennessean, Dr. Frist opened the first transplant center in the South at Vanderbilt University. In 1994 he left medicine and was elected to the U.S. Senate. He promised to serve only two terms, so at the end of last year, after 12 years, Dr. Frist retired.

During the four years that he was majority leader, Dr. Frist continued his practice of going to Africa on medical missions, and he began to see that the power of healing can go a long way to improving America's reputation in the world and, more importantly, providing peace and stability in the region.

Dr. Frist is back in Africa, traveling with his wife, Karyn, and Franklin Graham, the president of Samaritan's Purse, and is blogging for

Feb. 18: Doctor to Gorillas

My resting heart rate was too fast, 120 — that’s more than double what it should be. I was light-headed to the point that I had to sit down or lose consciousness.

I was panting, but the breaths were shallow and seemingly ineffective. I was well-hydrated and I had plenty of protein and sugar on board, but I was hypoxic, my strained muscles hungry for more oxygen.

At 11,000 feet I don’t know if I was helping things or hurting things by slowing down and deepening my breaths. I am at least a volcano’s distance away from any sort of medical facility. I hate to die a week before my 55th birthday! But we had made it to the top.

• Click here for photos of Dr. Frist and gorillas in Rwanda.

Click here for more photos of Dr. Frist's mission to Africa: Essay 1 | Essay 2 | Essay 3 | Essay 4 | Essay 5.

Slowly a massive figure rose from the bright green grasses in the clearing that had opened up before us as we stepped from the dense, wet forest.

Dark, heavy, slow and deliberate, the neckless figure was facing away from us. His thick, broad back was silver, contrasting with the glistening black of his head and lower body.

He grabbed a bunch of prickly green thistles with his enormous right hand, his fingers folding them delicately, and brought them up to his mouth. He slowly turned toward us, his eyes so human and so expressive. Would he charge us? No, he just took a wary look at us and then turned away and ate the thistles. (See picture).

Tracking through the mud and wet for hours was well worth this inspiring moment of meeting with the gorillas. And any sense of fear on our part disappeared as our trackers began a clucking noise that clearly communicated to the gorillas that we are friends, there not to disturb them.

Click here to watch video of Dr. Frist in Africa.

A proposed hour-and-a-half trek, seemingly straight up the massive volcano through dense jungle, requiring the trackers to use machetes to clear a path almost the entire way, turned into a four-and-a-half-hour trek through thinner and thinner air.

Gorillas move and, indeed, they had moved quickly in the direction away from us all morning. They travel in families, and the Susa family is the largest and most interesting of the habituated gorillas in the Virunga mountain ranges that bridge the juncture of Rwanda, Uganda and Democratic Republic of Congo.

So we visited them — and what a memorable visit it was.

I’d traveled to these remote regions of Rwanda in the heart of Africa for three specific reasons: to continue my longstanding study of the gorilla heart; to enrich my understanding of the potential of disease transmission between animal and man (HIV, SARS, Avian flu); and to further expand the concept of “medicine as a currency for peace” using a unique “one health” approach being pioneered by a group of veterinarians who were connecting health of a gorilla-centered ecosystem with health of a poor population that had been ravaged by genocide just a decade before.

About three months ago, I received an e-mail from my good friend and colleague Dr. Lucy Spelman, who was living in Ruhengeri, Rwanda, working with the Mountain Gorilla Veterinary Project (MGVP)… a long way from her previous position as director of the Smithsonian’s Washington National Zoo, where we first met.

We’d become close friends, primarily because doctor to doctor we both loved caring for and healing our respective communities (me people, she animals) and we shared a larger view about the oneness of life.

In fact, one day about six years ago, she discussed with me the case of a lowland gorilla at the zoo that had apparently prematurely developed a cardiomyopathy (diseased heart).

Knowing my profession was cardiology and my specialty end-stage heart disease (and heart transplantation), she asked me to come by the next examination of this gorilla to give my professional opinion on the diagnosis and prognosis.

You probably recall that about 25 years ago attempts had been made to transplant baboon hearts into humans (unsuccessfully); and I, as a surgeon, had routinely replaced diseased human heart valves with pig valves. The gorilla heart and the human heart are practically identical.

A month later, early in the morning while it was still dark, hours before the Senate would open up for the nation’s business, we were traveling along a winding road in the hills of Rock Creek Park, transporting a 350-pound gorilla — unrestrained but asleep — to the zoo’s medical facility tucked inconspicuously back in the wooded park.

Thirty minutes later, intubated and comfortable, the gorilla was fully examined with chest X-ray, appropriate blood work and a complete physical.

The powerful hands … I think that is what hooked me. They are huge. They are so human. The fingers so perfect but so massive, so large.

Little did I know at the time that six years later I would be 5,000 miles away seeing those same gorilla hands in the wild, delicately cradling the fresh thistles in preparation for chewing.

The gorilla heart is no different than yours or mine. We performed the electrocardiogram, which was normal. But the echocardiogram confirmed that the gorilla had suppressed or abnormal ventricular function.

Indeed, he had a cardiomyopathy, but he was only about 20 years old, way too young. The investigator in me said we must someday find out why … and that’s how my journey with gorillas started.

The huge silverback we spotted today at the Virunga National Park in Rwanda was the dominant, or chief, silverback in the family. This large family actually had three silverbacks (mature males), which is unusual, but Kurira was clearly the chief. And you could tell.

He surveyed his family throughout our stay, ready to protect the 2 1/2-year-old twins that would naively come playfully close to us, seemingly tempting us to join them in their frolics, or the youngest of the family, the 3-month-old that clung affectionately to his mom as she ate the tall grasses.

Mountain gorillas (gorilla beringei beringen) differ from the much more common lowland gorillas in size, form and behavior. There are only about 700 mountain gorillas in the world. Unless you’ve been in central Africa where Karyn and I are today, the Virunga Mountains or the nearby Bwindi Impenetrable Forest (Uganda), you have never seen a mountain gorilla, because there are none in captivity.

New Dimension of Health Care

We had traveled to these mountain forests to be with the gorillas and to explore a new dimension of health care, which I believe has real implications for mankind throughout the world. It is called “one-health,” conservation medicine or ecosystem health.

The “one-health” approach is based on ecology. If all living things are connected, then so are the threats — and solutions — to a healthy ecosystem.

The health of the mountain gorilla is intricately connected to that of people, other animals, plants, soil, air and water in the region. This connectedness opens up potential advantages to all, especially in developing countries where poverty is so dominant.

This program is being pioneered here by the Mountain Group Veterinary Project (, headed by Dr. Mike Cranfield from the Baltimore Zoo. I had come to Ruhengeri to spend two days studying the health of the mountain gorilla with these knowledgeable veterinarians.

They are modeling and making great strides not only in overseeing the health of the endangered gorilla population but also in implementing this innovative “one-health" approach community-wide, underscoring the importance of the human-to-animal-to-environment connections and capturing synergies and benefits to populations that would not otherwise occur.

Conservation medicine is an emerging discipline that constructively links human health, wildlife health and ecosystem health. I was introduced to this holistic approach while working with the gorillas over the past six years at the National Zoo, but I needed to come to central Africa to see it in action.

You see, Rwanda is the most densely populated, yet it has one of the richest, most diverse forest ecosystems in the world. Many of the most important and valuable natural areas of the world (nearly all tropical rain forest ecosystems) are situated in poor, developing countries.

These nations struggle to improve the lives of rapidly expanding populations with limited resources. These countries are characterized by poverty, providing limited options of making a living and little access to basic services.

The one-health approach integrates the inherent value of the natural resources (here the gorillas, the forests and the related ecotourism that brings in resources) with reducing the human-to-gorilla (and vice versa) potential transmission of disease, with creation of a comprehensive system of ongoing health maintenance for those working in the region of the park.

This model of “one-health” could be applied throughout the world (including the United States). It brings harmony and understanding to development and to the inevitable tensions that arise between development and improved standards of living, and respect and conservation of our environment.

The mountain gorilla Employee Health Program, established by the MGVP to provide local health care benefits to the employees associated with the protected mountain gorillas, is a pioneering example of an integrated approach to occupational and ecosystem health that provides a “win-win” solution to the interlocking problems of protecting the natural environment and advancing human well-being in a setting of poverty and very limited resources.

This newly emerging and innovative field of “conservation medicine” directly improves the well-being of peoples living near protected areas like the Virunga National forest.

It provides the local people with a vital good (health care) as a byproduct of living near and protecting natural areas that are so vital to our ecosystem. By directly contributing to the heath care of surrounding peoples, it has that added benefit (a variation of my “medicine as a currency for peace” philosophy) in that it fosters attitudes of good will and makes local individuals and communities motivated partners in environmental protection (and the well-being of the protected gorilla population).

And, indeed, over the long term, in a global sense it may help unite the interests that human beings have in their own health with a positive attitude toward the health of ecosystems and wildlife.

The health of the gorilla depends on its immediate habitat as well as the surrounding community that influences it; we can learn from these interactions. And that’s why I am here.

Karyn exercises for an hour (or more) every day aerobically. Maybe that is why she led the way so energetically to the top of the mountain through the heavy, green jungle. Literally, she led our group of about 20, following just behind Olivier (our head tracker who had to pull me by the hand up the volcano side the last hour … like a guardian angel).

She doesn’t like snakes or bugs or mosquitoes (or sleeping in mud huts, tukuls or tents). There were none. Just strenuous trekking uphill though dense, wet forests, thistles that stung like bees, a lot of slipping and falling along the freshly cut, muddy paths.

She impressed the porters, the trackers and the other veterinarians in our group — and me (proudly), as I struggled to keep up!

The gorillas! You have to just look at the pictures attached. They suggest their majesty. Their dominance. Their comfort and gentleness. Their affection for human interaction. They played athletically in trees, they did somersaults and they ate, carefully preparing their food.

They watched us as much as we watched them. They are mirrors of ourselves in so many ways.

These are the habituated gorillas. About a third of the 700 mountain gorillas are habituated, a third followed for research and a third just left alone.

This is where Dian Fossey did her work to save the mountain gorilla from extinction. Fossey led the way in the habituation of the gorillas and she is no doubt a heroine in protecting the gorillas, studying their behavior and putting an end to poaching.

The movie "Gorillas in the Mist" about her life is an accurate portrayal of our journey today.
But habituation introduces new potential problems.

Humans and gorillas have about 98 percent of the same genetic makeup. They are susceptible to the same diseases as we are, but their immune system is “naïve” to most human diseases such as measles and many viruses, which if contracted could lead to wiping out the whole population.

(Of interest to me because of my focus in the Senate in preventing pandemics and preparing for bioterrorism, this concept of no natural immunity in a population is why scientists are so worried about “bird flu” or avian flu in the human population today — we have no natural immunity. It is why the Great Plague devastated Europe in the 14th century and why our Native American population was decimated after the arrival of European explorers.)

Moreover, zoonotic diseases that occur in certain animals may become more lethal when they spread to humans. The deadly “new” diseases that recently moved to humans from animal reservoirs: HIV, ebola, SARS and avian flu. Now you see why I’m so interested in studying the gorilla-human relationship.

The vets from the MGVP I’ve come to visit are carefully studying the impact of having so many tourists see the habituated gorillas in the region. Will they spread an innocent human virus to the gorillas and lead to their destruction?

Careful preventive guidelines are in place and constantly being refined (e.g., no closer than 7 meters to a gorilla, limit visits to an hour).

What about safety? Yes, this is the region where thousands of innocent humans were slaughtered in the genocide in 1994. Over 800,000 people died in a period of weeks. I will have a lot more to say about this tomorrow.

Also, Virunga National Park had been a common route of illegal entry by Interahamwe genocide rebels into Rwanda (which has created problems in the past with destruction of forests for firewood and gorillas hunted for bush meat), but this is no longer a problem.

Today it is safe. Absolutely safe. I have no hesitation in recommending this journey for anyone (though you can be the judge of whether to see the Susa group or visit one of the families a lot closer to the base!).

We, and every group, travel with armed guards both in front of the group and behind for security. There have been no problems in recent times.

So what’s the biggest threat to the mountain gorillas today? The survival of the gorillas is threatened in three ways.

First, there is habitat encroachment, mainly from logging and the extensive small farm agricultural activities that abut the volcano park.

Second is poaching: Roads introduced for logging provide infrastructure for commercial bush meat.

Third is disease (outbreaks of Ebola virus in western Africa had a high mortality in chimpanzees and gorillas).

Today, especially in the controlled parks, disease emerges as the greatest threat. A number of factors introduce unique challenges for the gorilla population. The Virunga Massif and Bwindi Impenetrable Forest have sharp boundaries, with few existing buffer zones.

Human communities around the mountain gorilla parks have highly dense populations (500 people per square kilometer) and agricultural practices at the boundaries promote contact among gorillas, humans and domestic animals, increasing the potential for transmission of infectious diseases.

Lastly, the intense gorilla-viewing ecotourism for obvious reasons increases the potential exposure to disease.

Medicine is a currency for peace. And as I hope I have depicted, medicine and health can be a currency for development. By searching out all the relationships (even between gorilla and man, and man and environment), we discover new ways that medicine and health provide a common element to better the human condition.

Tomorrow we travel across the country to join a closed retreat of President Paul Kagame with his cabinet as they plan for the next year in their continued recovery and reconciliation following genocide.

• Click here for photos of Dr. Frist and gorillas in Rwanda.

Click here for more photos of Dr. Frist's mission to Africa: Essay 1 | Essay 2 | Essay 3 | Essay 4 | Essay 5.