A very special patient was airlifted under risky circumstances from the Johannesburg Zoo to the University of Pretoria’s (UP) Onderstepoort Veterinary Academic Hospital, after his condition had veterinarians worried.

When Makokou, the 34-year-old western lowland gorilla who had developed a worrying nasal discharge did not respond to treatment, Dr Kresen Pillay from the Zoo called for help. A team compromising specialists from the Faculty of Veterinary Science at UP, staff from the Johannesburg Zoo Veterinary Hospital, and a diagnostic imaging team from IMV imaging SA conducted the initial health exam of Makokou.

Makokou in the helicopter that was used to airlift him from the Johannesburg Zoo to UP's Onderstepoort Veterinary Academic Hospital.

After this examination, the specialists decided Makokou needed a CT scan. Professor Adrian Tordiffe, a veterinary wildlife specialist from UP, said the CT scanner at Onderstepoort used for horses and other large animals was ideal since Makokou weighs 210kg.

“The problem was the distance from the Johannesburg Zoo to Onderstepoort. It would have been difficult to transport him awake. Even with heavy sedation he would be traumatised by the experience and we wanted to keep his stress levels to a minimum. Road transport would take more than an hour each way and that would also increase the anaesthetic time and the associated risks, especially in heavy traffic,” Prof Tordiffe continued.

Makokou was given a sedative in fruit juice about an hour before Dr Pillay darted him with the drug combination which would provide a safe level of anaesthesia. They did not want to provide too much of the anaesthetic drug as he has fibrosis and thickening of his heart muscle. At the same time, they needed to provide enough anaesthetic to ensure he did not wake up in the helicopter during the 17-minute flight on Saturday, 6 June.

“Unlike heart disease in humans, where the coronary arteries are affected by arteriosclerosis, great apes develop fibrosis of their heart muscle tissue,” Prof Tordiffe said. “Up to 50% of adult gorillas are affected to some degree. The cause of the problem is still unknown. This can lead to acute death if the heart rhythm becomes irregular, or they can develop congestive heart failure.”

He added that in the end, it was decided to carry a gas anaesthetic machine in the helicopter to better control the level of anaesthesia and provide additional oxygen during the flight. The anaesthetic machine would take up a bit more space in the helicopter, making it even more crowded.

The NGO Flying For Freedom SA helped to arrange the transport in a helicopter big enough, which belongs to Mike Barnes of MCC Aviation. Barnes offered his services at no cost. Dubai National Air Transport Association (dnata), which has partnered with UP to protect endangered animals through the Wild Over Wildlife programme, has offered to pay for the CT scans.

After examining Makokou the specialists decided he needed a CT scan.

Professor Gerhard Steenkamp, a veterinary dentist and maxillofacial surgeon at UP, said, “This was the first time we transported a gorilla in a helicopter in South Africa, probably the world. It was also the first gorilla on which we did a CT scan.”

He added that the nasal discharge had been treated by the Onderstepoort Veterinary Academic Hospital with different antibiotic courses for three months without relief. “More recently a swelling appeared below his right eye and we were then called to come and assess him. During the initial evaluation on 20 May a pink mass in his right nostril was discovered. I was also not able to pass an endoscope into his nasal passages. We therefore decided to only do a biopsy and get him to Onderstepoort for the CT scan evaluation of his sinuses and nose. After the scan, we also tried to do endoscopy of the nasal passages and the sinuses, but the mass prevented us from doing any visualisation. The CT scan showed a complete blockage of the three main sinuses we are interested in.”

Makokou needs surgery in about three weeks. “We are still preparing. It will involve lots of technology to help us navigate the unknown. The sinuses border the brain and eyes and removing all the soft tissue masses may well prove intricate. During the surgery, we will also have an oral and maxillofacial pathologist, Professor Sonja Boy from Lancet Laboratories, to evaluate the tissue as we remove it from his nose. She will be able to tell us what type of tissue it is – polyps or a tumour,” Prof Steenkamp continued.

Following the CT scan, staff at the Johannesburg Zoo, including Katherine Visser and Sharon Tshikosi, who provide daily care to Makokou, were eagerly awaiting his safe return. “It was a major relief to all when Makokou woke up without complications and having no recollection that he had just made history,” Dr Pillay said.

“All of us at the Zoo are very thankful for the help, and it is a real pleasure when so many people from a variety of backgrounds come together to achieve a common goal,” Dr Pillay added.

Watch video footage of Makokou’s arrival at the University of Pretoria’s Onderstepoort Veterinary Academic Hospital by clicking here.