Managing an outbreak
In 2016, on my second trip to Ape Action Africa, I went to oversee veterinary care at Mefou to enable Babs, the permanent vet, to study in the North-West region of Cameroon. Providing veterinary care at the sanctuary always keeps you on your toes. You never know quite what the day will bring.
One day I’ll never forget is August 15th 2016. Late in the afternoon Mr. Appolinaire called me over the radio and asked me to go and look at Lola, a chimpanzee in Tommy’s group, as she was behaving strangely. I tried to get more details about what exactly she was doing but was met with the lilting tones of Mr. Apollinaire’s voice, “Come and see Docteure, come and see”. Typically I walked or cycled around the different enclosures in the sanctuary but, as dusk would soon be falling, Mr. Appolinaire came to pick me up on his motorbike so that I could check on Lola before we were plunged into darkness.
Lola was refusing to enter the night cage and was instead sat out in the enclosure surrounded by a heap of bananas. Her mouth was wide open and she was chewing on a disc of mushed banana. Something was clearly wrong. She was bright and keen to eat but didn’t seem able to swallow. By the next morning she had deteriorated. She was lying on her front with discharge streaming from her nose and a raised rash on her face. I was very concerned. I went to check on the rest of the group and, although everyone was bright and active, two of the animals had facial swelling. Now alarm bells were ringing that this could be an infectious disease outbreak. I’d never seen signs quite like this at first-hand. However, I had some ideas about what it might be, so I went to the vet clinic and checked a few medical reference books. This confirmed my fears. I trekked up to Bobo’s group, where the phone reception tended to be strongest, and made some calls. Rachel has a gift for reading people, whether in person or over the phone, and immediately recognised the potential severity of the situation. She arranged for her and Babs to return to the forest so that we could anaesthetise Lola that afternoon to examine her and collect some samples.
Devastatingly, Lola stopped breathing during her anaesthetic and we were not able to revive her. She had so much swelling around her airway that it was impossible to place a tube to help her breathe. We could now see that the raised rash lesions visible on her face were also present throughout her mouth, all over her tongue and extended down her throat. More phone calls, this time to the national authorities and the laboratory in the city. We submitted samples of the rash lesion and they processed them urgently and we got the result we expected: monkeypox.
Lola. Photo courtesy of Ian Bickerstaff
Monkeypox virus is thought to circulate in rodents in sub-Saharan Africa, particularly squirrels, without causing illness. However, when it jumps into other species, such as primates, it can cause disease outbreaks. The virus produces a rash similar to chickenpox, but is more closely related to smallpox, the only human disease to have been eradicated. It kills about 10% of humans who are infected. Given the challenges of managing and treating chimps we were concerned that we could see a much higher death rate.
As monkeypox is a rare and serious disease our first job was to notify the authorities and close the park to the public. We then had to think about how to prevent the infection spreading both to humans and to the other primate groups in the sanctuary. We immediately quarantined the group, limiting access to a small, dedicated team of caregivers. The keepers used their machetes to cut a special path to the affected group that enabled us to access them via a small hut where we could change into dedicated clothing and don PPE prior to coming into close contact with them. The outbreak was a huge challenge with additional animals becoming ill every day, some mildly but many with swollen throats and difficulty breathing. I trialled different medications and eventually found a combination of painkillers and anti-inflammatories that was very effective at reducing the swelling and making the animals feel better. Unfortunately the medications had a very bitter taste, but a combination of grenadine syrup and a strawberry milkshake drink that we could buy in town transformed it into a delicious treat. My role in providing these delectable treats provided the perfect cover for the fact I was actually the vet and soon made me a firm favourite with the group. They would begin whooping with delight when they saw me approaching. This good relationship was crucial as it enabled me to closely examine the animals each day and often be able to inject individuals with medications if they refused to take them by mouth.
The outbreak presented new challenges every day, including how to deal with waste from the group to prevent spreading infection, the need to separate sick individuals from more boisterous companions to enable us to give medications and balancing managing staff fears about contracting the virus with the need for close contact to care for the animals. The lowest point was when we found Janet dead one morning. It came as a shock. At the time, I was most worried about Daweii who had horrendous diarrhoea and was refusing food. He seemed to be wasting away in front of our eyes. Janet had seemed far stronger, retaining a good appetite. However, she was the only chimp to consistently refuse oral medications, so had been very challenging to treat. She was such a gentle soul that we had often been able to inject her with medication but this depended on her voluntarily coming close to us, whilst remaining far enough away from her companions to prevent them from thwarting us. Usually we try to keep sick animals on their own to facilitate treatment but with so many sick animals we just didn’t have enough cages to do this. Janet quietly succumbed to the same breathing difficulties, resulting from throat swelling and oral lesions, as Lola. Janet’s death made us even more determined to save Daweii. Barthélemy helped me to anaesthetise him that day and we filled him with intravenous fluids and medications. The next day he looked just as weak but did accept water and allowed me to squeeze the juice from an orange directly into his mouth. Over the next few weeks myself and Mr. Appolinaire sat with him for hours, holding his hand and offering him all the tasty things we could think of to tempt him, most of which he refused. By now he looked like a skeleton but, almost imperceptibly, he began to improve. It was a very long road to recovery but after weeks of medication, additional nutrition and TLC he eventually got back to full strength.
A young Daweii. Photo courtesy of Ian Bickerstaff
In the group of 23 chimps, 20 of them developed signs of monkeypox, Lola and Janet died, and Bolley lost the sight in one of his eyes. Most of the other animals made a full recovery thanks to the dedication of their caregivers, Barthélemy and Eric, who looked after the animals every day despite their concerns of contracting the disease themselves. Many of the other keepers took on additional work to enable Barthélemy and Eric to dedicate themselves to the affected group and reduce the risk of the infection spreading. In particular, Antoine and Elkast took on the care for all the other animals in the affected section. Mr. Appolinaire was a rock throughout the outbreak orchestrating all the additional cleaning duties, providing support to me and showing his unrivalled, heart-felt care for the animals, whilst fulfilling all his routine duties to his usual high standards. With the park closed for so long many supporters rallied around to help raise funds to replace the loss of income. Like so many events in the history of Ape Action Africa, getting through the outbreak was a real team effort relying on the help of many in Cameroon and beyond. It is certainly a time in my life that I will never forget and I can’t wait to visit the chimps I think of affectionately as “the monkeypox group” as they will always have a special place in my heart.
- Dr Stephanie Brien -
Dr Steph with caregiver Abdoulay at her leaving party in 2017
We will be forever grateful to Dr Steph for her amazing dedication and hard work on her visits to Ape Action Africa and particularly during the incredibly challenging time of the monkeypox outbreak. As Dr Steph said, getting through the outbreak was a real team effort, and we recognise how lucky we are to have such a fantastic team at the sanctuary and wonderful supporters who rally around to help us through difficult times. Thank you all so much.
