Gorilla Journal 40, June 2010
Conservation Employee Health Program Kahuzi-Biega
Historically, the Mountain Gorilla Veterinary Project (MGVP),
in collaboration with host country national wildlife, natural resource
and/or tourism organizations, has served the role of clinical caretaker
of the mountain gorillas. This has been through continued field presence
of veterinarians who coordinate clinical interventions and ongoing health
monitoring efforts, focused clinical research, and participation in international
meetings and other information sharing forums in addressing gorilla health
issues.
The potential exposure to and transmission of human and livestock diseases
to gorilla populations is the third highest threat to gorilla species
in general but the largest threat to protected habituated gorillas. In
2000, the MGVP Advisory Committee and staff, along with other invited
experts, produced a strategic plan for MGVP Inc. The plan included a focused
mission statement to "improve the sustainability of the habituated
gorilla populations" through a "one health" approach. Zoonotic
(passing from man to animal and vice versa) diseases and emerging diseases
are of primary concern and are particularly important when endangered
great ape populations are involved.
Tourists and their potential role in transmitting novel diseases to the
gorillas and/or trackers and guides is potentially a major critical-control
point for reducing the risk of human-disease transfer within the gorilla
population.
The conservation personnel (trackers and guides) have the greatest contact
with the gorillas. Therefore this group appears to be the most cost-effective
and efficient way to provide human-health interventions in a preventive
fashion for both the humans and the gorillas. The MGVP Inc. Employee Health
Program (EHP) was first established in Rwanda. The goals of the EHP are
to assess and improve the health status of the trackers, guides, porters,
researchers, veterinarians and other employees of the organizations working
in the parks with gorillas thereby reducing the risk of zoonotic disease
transmission between the gorillas and employees. Improving the health
status of the employees reduces the number of sick days, increases on-the-job
productivity, improves morale and can help enhance the overall health
of the families of employees. The program is used to identify critical-control
points for prevention of disease transmission between the gorillas and
employees and to develop recommendations and guidelines for researchers,
trackers and their families. Health education during these programs consists
of training sessions and provision of literature. The components of the
EHP include a survey questionnaire, medical history, a clinical examination,
diagnostic tests, and necessary treatments and vaccinations. All of the
information gathered is entered into relational databases to be used for:
- tracking employees who need follow-up for a health problem,
- developing an epidemiological profile of employees and factors potentially affecting the health status of employees over time (e.g. occupational, social),
- assessing risk of disease transmission between employees and mountain gorilla populations quantitatively, and
- indicating the health profile of the general population in the surrounding area.
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A Kahuzi-Biega National Park employee during a EHP health check Photo: MGVP |
The EHP has identified cases of infectious disease in humans that are
zoonotic, as well as some that are not, such as AIDS. Other incidental
but interesting findings, which, through treatment, have improved the
lives of the participants, are high blood pressure, diabetes and the need
for eye glasses.
The program is now implemented at Parc National de Kahuzi-Biega, Parc
National des Virunga and the original program in Rwanda and includes approximately
750 people. Basis of the program:
- In order to reduce the likelihood of disease transmission, new employees should be enrolled in an occupational health program before they are exposed to wildlife in a field setting. In the event that this is not possible, enrolment needs to be retroactive for current employees.
- An occupational health program should include a full medical history and a thorough physical exam by a qualified physician or nurse. Diagnostic examinations should include any tests deemed necessary by the physical examination to further a diagnosis plus screening, for human immunodeficiency virus (HIV) testing (consistent with local program standards) and appropriate vaccinations.
- Fecal screening for gastrointestinal parasites should focus on common parasites, such as hookworms, pinworms and tapeworms. Evidence of gastrointestinal parasites in any employee should result in immediate treatment. Periodic prophylactic treatment, especially for worms, may be called for, as well as routine fecal exams. Health and hygiene education should also be provided to reduce the incidence of GI parasites among employees.
- HIV testing should be at the discretion of host country health officials and should not be considered a contraindication for employment. In cases where HIV testing is offered, it needs to be done confidentially and those employees that are found to be positive should be monitored by the program clinician, with their duties adjusted according to their general health condition.
- Employee medical forms should be kept confidential and should be accessible only to persons responsible for administering the program locally. Employee informed consent should be obtained prior to any physical exam, sample collection, or testing. If any studies are to be conducted on the data, permission for their health results to be aggregated for analysis should also be obtained. There should be open communication between the employers, the employees and the program clinician, so that the employees feel comfortable to admit symptoms of illness and to provide samples. A clear policy regarding what will happen to people if they test positive on any screen, or the physical exam, should be developed so employees do not need to worry that if they participate, their employment will suffer. Also, clear policies need to be developed regarding what follow-up diagnosis and treatment is provided by the Employee Health Program, when employees will be referred to national health programs for follow-up, and when employees will be expected to contribute themselves to their own treatment. Employees need to know how often they will be offered routine clinical services, how they will receive their results, and how they can contact the program physician if they should have any questions or concerns.
In the Kahuzi program a total of 104 employees, all of whom are men,
participated in the program. Within this group, there is a large age range,
with the majority of individuals falling within the 30-59 years age range.
All employees of ICCN/PNKB complied with the members of the MGVP EHP team
and hospital staff. All individuals were in favour of the program and
made every effort to facilitate the work of MGVP. It is felt that MGVP
has established a strong working relationship with ICCN/PNKB and the prospects
for further compliance at the next upcoming Employee Health Program sponsored
by Berggorilla & Regenwald Direkthilfe are good.
Mountain Gorilla Veterinary Project