Suddenly, a group of gorillas—adults and their babies—surround us on all sides, munching on leaves and climbing trees. We hear movement above, and a large tree branch hits me in the arm. Surely, I’m about to be killed by the very gorillas I’ve traveled across the globe to see. I then realize that the branch was knocked down by a large silverback, who is simply letting us know that we are in his territory and that we had better respect that fact. With the message received and our hearts racing, we go back to staring, awestruck, at these incredible creatures. The silverback and his family go back to their business, healthy, content, and protected in the pristine forest that is their home.
Ten hours west of Kampala, Uganda, driving on dusty, uneven roads, lies the lush Bwindi Impenetrable Forest. The mountainous rainforest is home to 340 mountain gorillas—half the world’s mountain gorilla population. The road to Bwindi is jammed with honking cars weaving at breakneck speeds around potholes; people selling Stoney ginger beer, meat kabobs, and grilled maize; pedestrians; and animals. Vendors shout, trash smolders in small piles, and minibus drivers offer customers rides while barely rolling to a stop. Children run alongside the roads—sometimes supervised, sometimes not; sometimes wearing shoes, sometimes not.
Conservation Through Public Health
One organization is largely responsible for keeping Bwindi’s mountain gorillas healthy and safe from their human neighbors. Conservation Through Public Health (CTPH) is a small NGO—founded and led by Dr. Gladys Kalema-Zikusoka—working to preserve gorilla and human health in communities fringing on protected areas in Uganda, Kenya, Rwanda, and the Democratic Republic of Congo. Gladys is a veterinarian first and foremost (she is Uganda’s first wildlife veterinarian), but came to realize through her work in Bwindi that in order to keep her beloved gorillas in good health, the humans who lived in the small villages bordering Bwindi Impenetrable Forest also needed to be healthy.
When CTPH was founded in 2003, population density was very high in the Bwindi communities—200-300 people per square kilometer—and hygiene was poor. In tracking a scabies outbreak that had killed a baby gorilla in 1996, Gladys and her team determined that humans were responsible for the disease. Gorillas were coming into contact with dirty clothing on scarecrows while venturing into gardens to scavenge. They were also becoming ill with intestinal diseases from stepping in infected human waste. With education about handwashing and dish drying (which wards off waterborne bacteria) and the installation of additional pit latrines, human health—and therefore gorilla health—has improved in the communities of Bwindi.
CTPH’s Village Health and Conservation Teams (VHCTs)—made up of native Ugandans and managed by Alex Ngabirano, who is originally from Bwindi himself—work to educate their communities about the importance of hygiene and sanitation, family planning (important, in part, to slow the expansion of human settlements), and conservation of the forestland that is an extension of communities’ backyards. Gladys realized early on that all of these efforts are essential components of protecting wildlife, and that progress in each area required improvement in the other two.
Humans weren’t only threatening gorillas through disease transmission—they were also tearing down their habitat, using the forest for farmland and firewood. There were unfortunate instances of gorilla poaching, as well. CTPH has worked closely with the Uganda Wildlife Authority (UWA) to develop strategies to reduce pilfering of wood and other natural resources from the forest, including installing boundary markers throughout the forest, alerting community members to where the national park begins and ends. UWA and the local communities struck a deal in which the Wildlife Authority shares firewood and edible plants with the communities and contributes 20 percent of gorilla permit fees they collect to encourage residents to protect the gorillas that now bring them tourism income. Employment opportunities have increased for local communities, as police officers and park rangers are needed to patrol the forest. UWA also planted tea and chili plants along the edge of properties. These crops are inedible to all animals, so their presence keeps wildlife away, reducing human-gorilla encounters.
For the tourism industry’s part, there are now strict requirements for anyone who wants to gorilla track. People must keep a distance of at least seven meters, and if a tourist has any trace of respiratory or intestinal illness on the day they’re scheduled to visit the gorillas, they’re required to skip the adventure.
Conservation Through Public Health is a supporter of the One Health Initiative and a partner of the One Health Commission.
One Health Initiative
Recognizing that human health (including mental health via the human-animal bond phenomenon), animal health, and ecosystem health are inextricably linked, One Health seeks to promote, improve, and defend the health and well-being of all species by enhancing cooperation and collaboration between physicians, veterinarians, and other scientific health and environmental professionals and by promoting strengths in leadership and management to achieve these goals.
One Health (formerly called One Medicine) is dedicated to improving the lives of all species—human and animal—through the integration of human medicine, veterinary medicine, and environmental science.
One Health Commission (501(c)(3) organization)
To ‘Educate’ and ‘Create’ networks to improve health outcomes and well-being of humans, animals, and plants and to promote environmental resilience through a collaborative, global One Health approach.
Local Leaders Improve Trust
Despite desperate poverty in much of the country, examples of generosity, kindness, and hard work abound in Uganda. Sam Rugaba—a CTPH volunteer leader and the chairman of livestock, sanitation, and family planning programs for the organization in Bujengwe Parish—is one of those examples. He proudly takes us on a tour of his village, with stops at the primary school, cattle pasture, and his home, where he warmly welcomes us to chat more about the ongoing programs in the community. Sam carries himself like the leader that he is: He’s tall, holds a walking stick, and his presence is gentle and kind, yet commanding. He displays the utmost respect for those in his community—the headmaster of the school, the children, and the people walking up and down the hill who pass us on our tour.
Elected to be a volunteer leader for his village in Bujengwe, Sam built the trust of his fellow community members during his work distributing anti-malarial drugs as part of a government immunization effort from 2001-2005. A teacher by trade, Sam begins the tour of his village at the primary school, where we meet the sweetest children. We visit three classrooms—all small and dusty, with benches for sitting and simple notebooks for writing. As we enter the first classroom, the students stand and in perfect unison sing us a greeting song, welcoming us to their school. Their smiling faces and gentle voices are what stand out in the room—not the simple surroundings. We then visit the “baby class,” where children as young as three are also eager to say hello to our group. The novelty of seeing a muzungo—a white person—makes the children excited, but part of their exuberance, Gladys explains, is simply that “they are happy to be alive.”
Carrying One Child in the Stomach, and One on the Back
According to Sam, since the CTPH program started in Bujengwe, 70 percent of the women in the parish are using birth control (only 26 percent of married women are using birth control at the country level)—most of them choosing Depo-Provera. The popularity of the shot, only needed every 12 weeks, is attributed to it being undetectable—and for the same reason, the copper IUD is gaining in popularity.
Sam tells me that the women in his community are very appreciative of the program, and that planning their families has eliminated the “dilemma of carrying one child in the stomach, and one on the back.”
Much of this regional success can be credited to the dedicated work of CTPH volunteer leaders like Sam and Peace, who oversees programs in a different village in Bujengwe. Peace shows us the mechanics of giving the shot, and then shows us the logbook where she records each woman’s name, date of shot, and date of future shot. Her warm demeanor helps me understand why upwards of 20 women in her village seek out her services each month.
After the demo, she shows us the energy-saving cookstove she and her husband own—and the pot of ebihamba (beans, in Rukiga—the local language spoken by villagers in the Bwindi communities) bubbling away on it. Although the boiling pot makes the room almost unbearably hot, I stay nearby to enjoy the delicious smell.
Life and Preventable Death in Rural Uganda
Standing in a simple home deep in the hills of Bwindi, the gaping divide in global health and wealth smacks me in the face. I’m at the home of a family about to hold a funeral for their two-month-old baby, who died last night of a variety of complications—a death that would have been entirely preventable in the developed world. As I stand in the doorway willing away tears and making myself as small as possible, the incredibly graceful mother sits on her bed, next to a small coffin holding her deceased child. Gladys, in her steady, competent way, holds her hands and asks what happened to the child. The grief-stricken mother calmly tells Gladys that the baby hadn’t been well from birth, and had eventually developed a cough that wouldn’t go away. The child developed diarrhea, which was followed by constipation, and though the family had made a trip to the local clinic, there was nothing the nurse there could do to save the baby. This is a tragic, but common story in Uganda’s rural regions.
While Sam and Peace are reaching out to their neighbors through a community-based distribution program, others are providing healthcare in more formal settings in the Bwindi community.
Elizabeth Kukunda is a midwife at Kayonza Health Center and provides a variety of maternal healthcare services to the women who come to the center. She most enjoys working in the maternity ward and is especially inspired by “delivering and handing over a live baby to the mother.”
Elizabeth is kind, generous with her time, and straightforward. She was motivated to become a midwife because she “felt a spirit of serving and saving people’s lives from [her] beloved Aunt Jane.” She tells us that there has been a birth control pill stockout since July 2015, a full year earlier. Sam also mentions the stockouts, which happen when the Ministry of Health runs out of birth control supplies, resulting in no deliveries to the pharmacies, clinics, and hospitals that normally carry them. When pills and Depo-Provera are both in stock, they are the two most popular birth control options for women who visit the health center; with the absence of pills, Depo is the go-to choice.
Additionally, six out of ten women who visit Kayonza Health Center have switched to the IUD, a shift attributed to “sensitization” within the community through health talks given about family planning during antenatal clinics, as well as in outpatient departments. This is coupled with education and discussion at churches and other gathering places in the community, and the support of CTPH’s Village Health and Conservation Teams.
Though rapid human population growth is still straining the forest’s natural resources and breadth of gorilla habitat, CTPH’s family planning programs have, in effect, slowed the destruction of the forest. There has been a twelve-fold increase in new birth control users in Bujengwe and Mukono parishes since the programs started. There are fewer deaths and injuries from close encounters between gorillas and humans, and communities have better relationships with park rangers.
The holistic approach that Conservation Through Public Health takes toward gorilla health will be the lasting legacy of Dr. Gladys Kalema-Zikusoka. The benefits to the people of the Bwindi communities will be felt for generations as well. One health for one shared planet.