Veterinary science series. Clare discovers how vets in China keep baby pandas alive. Plus, a pioneering operation in Cameroon could transform the life of Shufai the gorilla.
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We share our world with some amazing animals.
And sometimes they need our help.
When wild animals get sick, it takes radical thinking, extraordinary
medical skills and great bravery, to treat them and save lives.
What are you doing?
In this series I'll be finding out how dedicated vets are taking
pioneering human medicine to transform animals' lives.
This is the trickiest ultrasound I have ever seen.
And vet Steve Leonard will be seeing animal medicine
pushed to the limit in the most remote places on earth.
Nowadays, these guys can get the kind of treatment that a few
years ago would be impossible.
From life-changing surgery for a gorilla deep in the jungle,
to an elephant who needs an X-ray at a human hospital.
This is big animal medicine as you've never seen it before.
I'm in South West China, a thousand miles from Beijing.
Here in the foothills of the Himalayas, hi tech animal
medicine could help save an entire species.
I've come to the Wolong Giant Panda Base.
It's home to the largest panda breeding programme in the world.
This is incredible, you think how difficult it is to breed pandas,
how endangered they are in the wild and to see so many of them here.
Where are you going?
These cubs are the latest of 197 bred here so far.
They're using human neo-natal techniques to help keep them alive.
But it's not just the babies who need specialist care.
Sometimes the very few giant pandas left in the wild need
This is a panda called Zhu Xia, which means purple dusk in English,
and she was rescued from the wild.
She's about 16 or 17-years-old and she'd come down
from the higher ground because she had a problem,
she couldn't feed herself, and she seems
remarkably comfortable around humans
and the vets here told me that it's almost as if she came down from
the higher ground to look for help and went to an area where there were
people, and luckily they brought you to the right place, haven't they?
Zhu Xia's behaviour is extremely unusual as pandas are normally
The team here think there must be something wrong with her
and she could be in pain.
Determined to find out what's going on, they're taking Zhu Xia for
a scan in a human MRI machine that's been adapted for the panda bears.
Zhu Xia's been sedated as she needs to be kept completely still.
So I'm going out now before the scan starts.
She just fits under it. You see how big her rib cage is?
The MRI scanner builds up 3D images of Zhu Xia's tissue and organs.
Ten years ago it would have taken major surgery to examine
her in this kind of detail.
Now, it takes just 20 minutes.
Well, she's still a bit groggy but Zhu Xia's
just starting to find her feet again.
The team will now check every image to find out what's wrong
and if there's anything they can do for Zhu Xia.
But in more remote parts of the world, there aren't
specialist vets, and the kit they need, on the doorstep.
In the jungle of Cameroon, in West Africa, Rachel Hogan is
waiting for a team of pioneering medics to arrive.
She saved Shufai the gorilla's life once.
Now he needs her help again.
Did you do those branches before?
Rachel runs the Mefou Primate Sanctuary.
She came out here from the UK as a volunteer 13 years ago
and never left.
At night we'll put the baby gorillas in here
and then the baby chimps here.
The sanctuary is a haven for orphaned gorillas,
rescued when their mothers have been killed by poachers
for the illegal bush meat trade.
When Shufai's mother was shot nine years ago,
he was left fighting for his life.
So Shufai arrived when he was just over a year old, um, which is
a very delicate age for a gorilla because they're very emotional
and they also retain the memory of what's happened.
He had horrific gunshot wounds to the side of his head that had
gone through his ear and then his one arm was a complete mess
because he'd got the gunshot blast from holding on to his mother.
He was absolutely terrified.
And I just got a chair
and I sat outside the cage and at night he would wake
and he would cry because he was so upset.
Gorillas are very, very emotional and they're very, very fragile.
You need to be able to get them emotionally secure.
If you don't have that, they literally just give up and die.
For two weeks Rachel didn't leave Shufai's side.
And then something changed.
He sat up and I just remember him just looking at me
and I was looking at him and he was looking at me
but I could see there was a difference in his eyes.
I just picked him up and he just wrapped his arms round me.
And that was it, then, it was like he had decided he was going to live.
Rachel had saved him.
Although the gunshot injuries to his arm meant he couldn't climb trees,
Shufai soon began a new life with the other gorillas.
For six years he thrived with his new family.
But, recently, Shufai started struggling to
walk on his damaged left arm.
Rachel feared that his childhood injury was getting worse.
And he seemed to be in pain.
But she's found a team of specialist vets who think they can fix his arm.
Today, they arrive from the UK.
They've been able to bring all the kit they need
to set up an operating theatre out here in the jungle.
Surgeons Sandra Corr and Damien Chase have been studying
X-rays of Shufai's wrist, taken a year ago.
These are our radiographs from...
And have devised a pioneering operation.
So the hand is twisting off, it should all be nice and straight.
As Shufai gets older, the outer bone of his arm is growing faster than
the inner one that took the bullet, forcing his wrist to curve round.
Sandra is going to remove some of the excess bone
and then insert metal plates to hold his wrist straight.
Bring this hand around.
It's a complex operation that no-one's ever tried before
on a gorilla.
The team want to take some up-to-date X-rays
to finalise their plan.
Shufai's taken, in style, to the make-shift operating theatre.
So this is the effected arm and it should be lie flat down
on the plate but you can see how bent it is and it's
not going to be a particularly good X-ray but that's going to help us.
But one look at the X-rays reveals something's not right.
The X-rays, as soon as they came up, they looked worse,
considerably worse than last year.
In contrast to his healthy right arm,
Shufai's left wrist has deteriorated much more than they expected.
It's really crunchy which means the joint itself is pretty badly
damaged and the elbow also is really crunchy.
If you look here, these carpel bones are just a big jumble of bones.
The wrist is what we were feeling when we were him checking earlier,
it's just a big bag of bones,
which is why I don't think this surgery's going to help him.
The operation they hoped to give him is out of the question.
Sandra thinks there might be only one option left to help Shufai,
but it's not what anyone wants to hear.
At every point we thought we could fix him and I think this is
the first time we've been absolutely certain that we can't.
Based on that, we have to think about amputating his arm.
It's such a shame because he's been through such a lot.
They hope that by removing his arm now, they'll stop Shufai's pain
from getting worse as he grows and that he could get his old
But it's a horrible choice for Rachel to make.
It's really, really difficult.
Gorilla's, they need their arms, they use them for playing,
climbing trees so to remove one arm for Shufai is huge.
What if the rest of the group kind of push him out?
It's probably one of the hardest decisions I've had to make.
With the vet team due to fly back to the UK, Rachel has just
24 hours to decide if the operation should go ahead.
In India an army of international vets are preparing
for a wildlife crisis.
They'll borrow techniques used in human disaster relief.
I'm in the city of Ahmedabad in the northwest of India.
Every year it's home to a unique festival.
It's called Uttarayan
and it's all about the return of Spring and the arrival of the sun.
And, for hundreds of years, they've been celebrating
this with feasts, with prayers, and an epic kite flying contest.
Thousands of paper kites are flown in an ancient competition.
The aim is to slice down other people's kites
and be the last one flying at sunset.
The secret lies in the string.
It's coated in glue, laced with razor sharp, powdered glass.
But it has some unintended consequences.
Ahmedabad is on the migration path of thousands of birds
and home to the highly endangered Indian vulture.
For all of them, the kite strings are a deadly hazard.
Small animal sanctuary Jivdaya has been
transformed into one of the largest animal A&E's on the planet.
25 vets and thousands of volunteers are expecting to
treat over a thousand birds.
On every single one of these tables,
there's a bird being operated on at the moment.
And these baskets here are the patients waiting for surgery.
I've never seen the scale of this sort of operation before.
It's amazing what they're doing, with all of these volunteers,
and yet they're still not keeping up with the number of birds coming in.
Most of the casualties need complex surgery to reconstruct their wings.
Back in the triage department, there's a commotion.
A vulture's brought in, in a critical condition.
But there's no way they can attempt surgery yet.
It's in shock, the bird's in shock.
The vulture's lost so much blood he's slipping out of consciousness.
They need to give him fluids immediately
or he'll die on the table.
Chief vet Dr Shachi Jahad has to get an intravenous
drip into a vein in his leg.
There should be a great big sort of vessel shouldn't it,
a bird this size, but you can't get in?
The bird's lost so much blood that actually they're really
struggling to get a vein to come up and it's really important to
get those fluids in there to get that blood pressure up.
In any animal that's bled,
they're not going to die from lack of blood, it's lack of blood
pressure, being able to get the blood to go round the body.
He's done it.
Oh, steady, steady, steady.
The vulture gets the fluids he needs.
Yeah, that's dripping OK.
Now Shachi needs to see if he can repair the damaged wing.
If the kite string has cut right through the bone,
the vulture won't fly again.
You can see the string in the bone.
-Oh, it's embedded in the bone.
-In the bone, yeah.
But, luckily, it looks like it hasn't gone all the way through.
-You'll have to reconstruct that muscle.
You'll have to pull all that back together.
-Reconstruct all the muscles.
You think that this vulture has a good chance of flying again?
The vulture was rescued just in time.
There's a patient on every table and every ward is full.
But more victims keep arriving.
Not all of them will make it.
But the team managed to save nearly 2,000 birds and three bats.
Over the next few weeks,
all the recovered birds are released back to the wild.
Treating animals in remote corners of the world can take some
improvisation, especially if your patient weighs nearly four tonnes.
Young British vet Will Thomas is trying to help Tonkoon, an elephant
who's in a critical condition after being shot in the leg.
Laos, the country once known as Lan Xang,
the land of a million elephants.
As it has been for centuries,
Laos is still home to some five hundred domesticated elephants.
Tonkoon and his mahout, Iya, have worked together for 15 years
but now they're in trouble.
This is where he was shot, so obviously quite painful.
It's my opinion that the bullet's still inside there.
It's obviously infected and it's swollen and it's painful.
Will needs to try and remove the bullet and get that infection
It could be the end of the line.
We're in a lot of trouble.
Before he can operate, Will needs to take Tonkoon for some X-rays.
But he won't get on the truck.
After three hours of trying, Iya comes up
with the right motivation.
The elephants are afraid of injections
so whilst they were shaking their bottles, they shout,
"sakya, sakya" which means, "injection, injection".
So he moved rapidly in the opposite direction.
I'm so unbelievably happy.
I can't believe that we finally got him on and we can go.
There are no specialist animal hospitals here.
The only X-ray machine Will could find is at the local human hospital.
It's taken two weeks, but he's persuaded them to let him
use their machine.
It's the hospital's only X-ray machine, it costs, you know,
40,000, it's the provincial hospital.
If he were to hit the machine, if he were to break it,
there would be really quite a disaster.
There's no way Tonkoon will fit inside the building
but the doctors agree to bring their machine out to the car park.
So this is the X-ray machine.
We have to look after it and just hope it's strong enough.
Will needs to take two X-rays, one from the front, the other
from the side, so he can work out exactly where the bullet is.
So you see, this is the X-ray plate.
You take the shot from the X-ray machine
and the image is developed here.
This needs to be on the opposite side of the leg to the X-ray.
To get an image, Will needs Tonkoon to keep completely still,
even just for a few seconds.
Finally, they get their chance.
They bring the precious machine as close as they dare.
Tai, take the photo.
Take the photo.
The electricity's not enough?
It's just, sometimes in Laos, the power fluctuates so much that it
might just be that and the hospital, there's not enough at the moment.
By the time the power's back, Tonkoon's had enough.
Will's hopes for the vital X-rays are fading, when Iya has an idea.
This surprisingly simple approach seems to work.
Phew, yeah, what an X-ray. Oh, my God.
Now, Will just needs the second image.
But Tonkoon's been on the truck for three hours.
I think he's getting too anxious and too worked up.
All the people and all the noises. I really want to take the X-ray
but I think I'm going to have to abandon it.
It's going to be dangerous both for him and for us.
Tonkoon's taken to the elephant sanctuary for the night.
He didn't get the two X-rays he needs, but Will's not giving up.
Tomorrow he'll try and remove the bullet.
At the Mefou Primate Sanctuary in Cameroon, Rachel has spent
the day facing one of the hardest decisions of her life.
X-rays have revealed that Shufai's wrist is more damaged than
Removing his arm could stop him living in constant pain.
But no-one can be sure how he'd cope with only one arm.
Gorilla's have a strict hierarchy which is all about physical status.
Rachel fears that Shufai, who is extremely sociable, could be
rejected by his troop.
By midnight she decides the surgery should go ahead.
It hasn't been an easy day.
We've had Shufai from when he was a little boy and he has been
through such a lot, but after the team sat us down and explained us
everything, and then went through the X-ray and,
you know, what the pain that Shufai was feeling,
the whole reason we're all here is because of Shufai.
And what we want for Shufai is the best. Now whether that was that
they were able to do the original surgery and to plate everything
or obviously now, things are different and it means amputation.
The operation has to happen the next morning.
Primate specialist Sharon Redrow is here to inject him
with an anaesthetic.
But Shufai's seen this stuff before and knows something's up.
There's a good boy, there's a good boy.
Who's that funny person?
Even with Rachel's encouragement, Shufai won't go near Sharon.
But there is one person Shufai's always trusted.
Rachel gives him the injection.
He won't worry, he didn't feel anything.
Shufai is taken for a very different operation to the one they'd planned.
No-one likes to amputate things. It's a horrible thing to do.
But you have to do it sometimes, if it's the right thing for the animal.
So we're going to start.
Starting, keep an eye.
So let's make a big...
We're all built the same from domestic cats and dogs,
just variations on a theme, but the thing is,
it's those slight variations
that can give us the surprise that we're not expecting, such as,
is there going to be an artery where we didn't quite expect it?
We're just starting to cut muscle, which is bleeding quite a lot.
After two hours of surgery, they've removed all the muscle.
We're down to the bone on all sides.
For Rachel, it's all too much.
Now, all that remains is for Sandra to stitch up what's
left of Shufai's arm.
That was just to make it as neat as we can. We're nearly there.
Shufai should wake up within an hour.
Horrible to see him right now.
But everything went fine, so fingers crossed and see how he is
when he wakes up.
But two hours later, Shufai is still asleep.
We want him awake and then we know it's done.
I'm paranoid he's not going to sit up.
Come on. Are you waking up?
Finally, after one more agonising hour...
..Rachel sees Shufai open his eyes.
He's made it.
He's a little fighter, eh, Shuf?
No-one knows how Shufai will react
when he realises what's happened.
But they're hoping that once he's
fully recovered, he'll be pain-free and back with his troop.
In China, Zhu Xia has had an MRI scan to help vets explain her
They found no sign of what might be wrong
until they examined a scan of her back.
-This bright spot?
-So would that cause her pain?
-I think so, yeah.
Zhu Xia's damaged disc explains why she couldn't
fend for herself in the wild.
But here at the sanctuary, they can treat her
with medication that should give her a more comfortable life.
The aim at Wolong isn't just to look after individual pandas.
I'm heading to the maternity ward to see vets try out an ingenious
idea that could help them save the species.
This is Shi-Shi and she's 14-years-old.
You can see she's got a cub in there,
she gave birth just a couple of months ago.
You can see this cub is doing really well,
he's strong and she's bonded very, very well with him.
She's finished cleaning him and now it's cuddles.
But he isn't Shi-Shi's only cub.
She had twins.
The other one, Sheitza, is struggling to survive.
His mother rejected him.
Panda cubs are so difficult to care for, when mothers like Shi-Shi
have twins they have to choose just one to look after.
In the wild, the other one is left to die.
Since his birth,
Sheitza has been looked after by the expert team here at the nursery.
Hey, you're quite heavy, aren't you?
He is quite heavy, it's just like holding a heavy baby, isn't it?
Do you want to come in here?
They're currently raising five rejected twins in the nursery.
At birth pandas are some of the least developed
and helpless of all new-born mammals.
Babies like Sheitza have to grow a staggering 900 times in size
to become the giants that their parents are.
THE PANDA SQUEALS
He doesn't like having his face washed. "Get off," he says.
There we go. All done.
But this specialist care alone isn't enough to keep cubs
like Sheitza alive.
Sheitza needs vital anti-bodies that help him fight infections.
And they're only found in his mother's milk.
So the team is going to attempt to swap the twins.
First, they have to separate Shi-Shi from her favourite.
This is Mr Fung
and he's going to get that cub out, so he's tempting Shi-Shi
away with panda cake, special cake that she likes, get her through
in that section because, remember, although she looks adorable,
she's a bear and she could, with one swipe, do him serious damage.
So he's going to take this cub out.
Hey, little one.
So far, so good.
They're identical twins and, to me, they look exactly the same.
But surely their mother will be able to tell the difference?
Here he is.
This is Sheitza's chance, but it's a risky strategy.
Not only is his mum armed with claws and teeth,
but at 15st she could crush him.
She's going straight for him.
Will she realise that this is a different cub?
It has to be nerve-racking because you never quite know
whether she's going to accept the twin cub and continue to
think it's the same one but, despite fairly intense inspection,
it seems that she's quite happy, this is her cub.
And it means he can now get the love and attention from his mother
that he needs.
By swapping the twins,
Shi-Shi thinks she's only looking after one baby.
They'll be switched between their mother and the nursery
every week until they're six months old.
This simple but clever idea and three decades of research has
helped to keep every cub born here alive.
Do you know, you read so much about pandas and you see
so many photos, they just look cute and you think they can't possibly
be like that in real life and you get here and they are.
Some people think you're over-rated but I don't think so!
In Laos it's the morning of Tonkoon's surgery.
Will needs to try and remove the bullet in Tonkoon's leg,
with just the one X-ray he managed to get.
Obviously this view is only from the side,
so it tells me how high up but not exactly how far over it is,
but this is the only view that we could get.
Tonkoon will be awake throughout the operation.
Elephants are so heavy, their body weight can
crush their internal organs if they lie down too long.
We'll just sedate him
and he'll still be conscious of the whole procedure, which is
better for him, although it's a little bit more difficult to operate
on him when he's still aware of what's going on around him.
Already his trunk is dropping.
His eyes are starting to go.
Ten centimetres above the ankle chain,
Will makes his first incision.
I can feel a tract where I think the bullet went,
so I'm just bluntly dissecting
so no sharp cuts which reduces the risk of haemorrhage.
Elephants have such high blood pressure,
Will won't be able to control the bleeding if he hits a major artery.
Good boy, good boy. It looked to be around this level.
He burrows deep into Tonkoon's leg, but there's no sign of the bullet.
Then Tonkoon starts to wake up.
SPEAKS LOCAL LANGUAGE
I'm deep enough. I know I'm in the right level.
I know I'm far enough in, it's just how far to each side it is.
Will expands the incision to either side,
but without that second X-ray he's working blind.
Where are you?
Eventually it's too risky to keep cutting.
It's really frustrating but I think if I keep going we're just
going to cause more damage than we're going to solve.
All Will can do is try and clean out Tonkoon's wound.
We found the pocket of fluid.
I'm just going to scrape out and clean out that area
and just gently debride away.
For the elephant's sake, it's better to close him up
and clean the infection as we sew.
It's really difficult not having an X-ray machine here.
At home in Europe I would be able to take multiple X-rays whilst
we were doing the surgery,
find out exactly where my instruments were in relation to the bullet,
but it's just really galling not to have found that bullet.
Elephants have very strong, but slow, immune systems.
It will be a month before Will knows if he's done enough.
The only way to treat some animals is to get right into their world.
To care for his patients, one vet has invented a whole new
kind of underwater medicine.
I've come to the Churaumi Aquarium on the island of Okinawa,
500 miles south of mainland Japan.
-Hello, nice to meet you.
Hello, how are you?
I'm going behind the scenes with vet Dr Keiichi Ueda
to see some of his patients.
The manta rays.
They're beautiful, the way they fly through the water,
-you can really see their wings moving.
Although close relatives to stingrays,
these four-metre-wide giants are completely harmless.
To try and protect this critically endangered species, in 2007 Churaumi
became the first place in the world to breed them in captivity.
This is incredible footage, the baby is just about ready to pop out.
Gosh, it really is wrapped around like a sort of scroll of paper.
Oh, there's the baby.
So it comes out rolled up
and there's all this fluid around it.
And swims away.
No-one had ever witnessed this before.
They now knew what happened when baby mantas were born.
But last year, Keiichi and his team had to intervene
when one pregnant female fell ill.
Keiichi had to deliver the premature baby.
He knew it was developed enough to survive because he'd been
able to monitor the pregnancy using a unique underwater scanner.
So this is an ultrasound machine,
-the same as you would use on a human?
-So this goes on and makes it completely waterproof?
Now, after a pair of mantas were spotted mating,
Keiichi needs to find out if the female is pregnant.
You've got to carry this and you'll be scanning her with this?
-On her back?
To have any chance of finding out if she is pregnant,
Keiichi has to try and get the scanner in exactly the right spot.
But manta rays have to keep swimming to breathe.
This is the trickiest ultrasound I have ever seen,
because Keiichi has to get his speed and his balance perfectly right
to swim at the same pace as the manta ray, while trying to
scan her, there's another diver at the front keeping her straight.
Keiichi's previous ultrasounds have revealed that there is no
umbilical cord or placenta feeding the baby oxygen in the womb.
Instead, they constantly gulp a special uterine fluid to breathe.
Do you think you got it?
Let's check the monitor.
Yeah. So this is giving us images.
What can we see here?
But right now there's only one thing they want to know.
Is she pregnant?
It's just a shape that they're pausing over.
But this time it's not what they're looking for.
So there's nothing on that image and that's what would tell us.
-Oh, what a shame.
Keiichi's invention will not only help ensure the safe arrival
of any future babies, but it means we know things about manta rays
that would be impossible to find out any other way.
And Keiichi hopes this could help efforts
to save this endangered species in the wild.
It's been two months since Tonkoon's operation.
Will couldn't remove the bullet that was lodged in Tonkoon's leg.
But we're on our way to see if he did enough
to stop the chronic infection from spreading.
What are the signs that will make you worry today?
What I really don't want to see is, I don't want to see him
with pus coming out of the wound, I don't want to see him
very lame, very painful, not able to walk,
and those two things really would make me very concerned.
Wow, look at him.
If the infection has gone,
Tonkoon's damaged leg should feel firm to the touch.
-He's not keen, is he?
-I'll just try to have a quick touch.
A quick feel, yeah.
It feels really good. It's really hard.
It's not painful at all. I'm happy.
I think it's now going to settle down
and he can continue with his normal routine.
Well, he doesn't seem to be lame at all, which is great.
-Will he let me have a quick...
-Definitely give it a go.
All right, wee man. Let's have a feel. Oh, yeah.
Cleaning out the infected tissue meant Tonkoon's own healing
process could take over.
The bullet's probably just been sort of walled off with scar tissue
-and it will stay there forever, won't it?
SPEAKS OWN LANGUAGE
He was just saying that after you returned and he spent the two months
recuperating, he's now working at least as well as he was before.
Fingers crossed he stays safe.
Eight months ago, everything changed for Shufai the gorilla,
when vets had to amputate his arm.
Hello, hello, Shufai.
Rachel's big fear was that Shufai would be rejected by his troop
after the operation.
When he came round from anaesthetic one of the other gorillas
was in a satellite cage next to him
and he showed them his arm and they were all looking at it
and then he was looking at it and they were putting their arms
through, touching it really, really gentle, touching it and then
smelling their hands.
And then, when he went into the group, they were all really gentle,
everyone was really curious, so they knew,
you know, that something was different and even with playing,
they would wrestle with him but they would cradle his arm with their
other hand, so they all adapted to him. It was fantastic to watch.
Good boy, Shufai.
This is Yabba next to Shufai, who is his best friend and after the
operation carried him on his back, so he's quite protective of him.
He's going to lob things at me.
Thanks, Yabba, that's kind.
You see how well Shufai looks.
He's built up the muscle again across his back and he looks very
contented and he's completely integrated into the group,
they're still quite protective of him as you can tell, but he does
his thing and he's maintained his role as peacemaker in the group.
He's the good boy in the class.
The vets did a fantastic job, it was a risky operation
but it has paid off and it was the right decision to make.
Are you about to throw it at me again?
He never, ever climbed trees when he had both arms
because the pain was too much.
The first time he climbed a tree was with one arm.
And I nearly had a nervous breakdown.
He uses his chin and his other arm to just pull himself up,
but when he had both arms he never used...
You never saw him in a tree and now you never see him
out of a tree, so all of my worries are completely disappeared now.
He's a completely different little boy now.
Although animals across the world face threats to their survival,
we can now look after them in ways we never could before.
Next time, vets give Tandy the first ever Rhino skin graft.
A seal with a mystery illness needs a CT scan.
And could pioneering eye surgery help Rosemary, a blind orang-utan,
see her daughter again?
Clare Balding and vet Steve Leonard find out how developments in human medicine are transforming the way sick animals are treated around the world. Clare discovers how vets in China keep baby pandas alive. Plus, a pioneering operation in Cameroon could transform the life of Shufai the gorilla, and an elephant in Laos with a gunshot wound has to have an x-ray at a human hospital.