EVEN for rehab, this is no ordinary hospital. For a start, most of the staff are volunteers. One of them, Sharyn Brown, shows me around the wards 鈥� shady, quiet enclosures dotted with gum trees, in which the patients sit. Whiteboards record their progress and requirements. 鈥淣o melaleuca leaves,鈥� one sign reads. Brown tells me that the hospital employs a 鈥渓eaf searcher鈥�, who scours the local forests to find foliage for dinner time. 鈥淭his one,鈥� she explains, pointing to a patient, 鈥渃ame from a part of the state where melaleuca doesn鈥檛 grow, so it would make him sick.鈥�
Welcome to in New South Wales. This unique facility treats around 250 animals each year from across Australia. Some have been hit by cars or attacked by dogs, others have fallen prey to a variety of illnesses, but perhaps the most troubling group are those with serious burns. With wildfires on the increase in the country, burns have become a serious and growing concern for the staff here. Now, however, a new discovery has led to a surprising treatment regime that includes koala faeces, or 鈥減oo shakes鈥� as they are affectionately known.
鈥淜oalas are pretty chilled and good to work with because they usually let you help them,鈥� says Cheyne Flanagan, clinical director at the hospital. When she started working here 30 years ago, it was just a job, she tells me, but she has grown to love these marsupials. She has also become aware of their idiosyncrasies. 鈥淜oalas confound the textbooks. They just don鈥檛 react to treatment in the ways you would expect,鈥� she says. 鈥淭hey鈥檙e fascinating and puzzling from a clinical viewpoint.鈥�
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鈥淭he youngest koalas were treated with the facility鈥檚 special poo shake concoction鈥�
Much of the problem is connected to their diet. Eucalyptus leaves contain various toxic chemicals, so the koala鈥檚 liver has evolved to rapidly break these down before they do any harm. As a result, it also processes pharmaceutical drugs very efficiently. This makes treating burned koalas a big challenge: the antibiotics and painkillers they are usually given can have little effect. What鈥檚 more, koalas caught up in wildfires are often too traumatised to cope with surgery, so can鈥檛 have skin grafts. Yet successful rehabilitation depends on repairing damage to burned paws, because without at least two healthy claws, a koala can鈥檛 climb. And if it can鈥檛 climb, it can鈥檛 survive in the wild. However, Flanagan and her team have now discovered a way around these difficulties.
In 2017, a devastating wildfire ripped through Limeburners Creek, 20 kilometres north of Port Macquarie. Koalas were known to live in the forest, so, once the blaze had subsided, Flanagan and 12 volunteers went in search of survivors. 鈥淚t was deadly quiet and the whole forest was covered in white ash,鈥� says Flanagan. The team spread out in a line to comb the area, aware that time was of the essence. 鈥淚t鈥檚 the radiant heat that is often the most damaging after a fire. It cooks the poor animals, sometimes for days. It鈥檚 like a microwave, burning through the skin and melting the keratin in the koala鈥檚 fur,鈥� she says.
The rescue party managed to find eight animals in good enough condition to bring back to the hospital. 鈥淭he trouble was, the koalas were just petrified,鈥� says Flanagan. 鈥淪o we decided not to take them into surgery 鈥� they were too stressed.鈥� Instead, they were simply housed in separate enclosures with plenty of water and fresh eucalyptus leaves. Drugs were kept to a bare minimum. However, the two youngest koalas were fed with the facility鈥檚 special poo shake concoction.
This treatment was inspired by something koalas do in the wild. For about a month while a joey is being weaned, at 6 months old, it consumes pap 鈥� a watery mixture of partly digested food and bacteria produced in part of its mother鈥檚 gut called the caecum. This boosts the joey鈥檚 gut microbiome, helping it fight infection and digest toxic gum tree leaves. Flanagan鈥檚 team feed orphaned joeys pap or, if that鈥檚 not available, regular faeces, and they did the same with the two infant koalas rescued after the Limeburners Creek fire.
Koala heal thyself
Within weeks, all eight injured animals had started putting on weight. Their claws and nail beds were healing too. 鈥淚t was mind-boggling,鈥� says Flanagan. 鈥淭hey healed themselves just by being left alone.鈥� In fact, their recovery was faster than seen in koalas who have surgery. She believes that timing was crucial. Burned koalas appear to have what she calls a 鈥済olden three months鈥�. Burns need to be cooled quickly, and any infection needs to be brought under control 鈥� she compares it to the 鈥済olden hour鈥� for humans who have been burned. The revelation was that a bit of pampering and a healthy gut are enough to do the trick.
These findings are not yet published, but they are already making waves. 鈥淧oo shakes are controversial among researchers,鈥� says Flanagan. Some think that they risk transmitting infections, and others see them as a rather unpleasant waste of time. However, support for the idea is bolstered by the growing realisation that the gut microbiome plays a vital role in health and disease, and can be manipulated using faecal transplants. In fact, Michaela Blyton at Western Sydney University is so enthusiastic about the potential of this approach that she wants to extend it to adult koalas. She has just finished a trial of 鈥渃rapsules鈥�: pills of fresh faeces designed to break down when they reach the small intestine, so that the bacteria they contain are not damaged by stomach acid.
Thinking even bigger, Flanagan believes that her team鈥檚 findings could have human applications. As with koalas, if someone is burned and subsequently infected, they can develop sepsis: severe systemic inflammation that can lead to organ failure. Worldwide, sepsis is a major cause of death for people with severe burns. One idea that is being explored by the National Institutes of Health in the US is to reduce this risk by administering the equivalent of a poo shake. Another possibility is using the approach to help people who, like koalas, don鈥檛 respond to medication, and people with liver disease who can鈥檛 tolerate drugs.
If lessons learned from treating koalas can save human lives, this could be a win-win. Claims that koalas are 鈥渇unctionally extinct鈥� may be premature, but according to conservation charity WWF, they will be if habitat destruction continues at the current rate. Perhaps governments will protect them if they can help medical research, says Flanagan. 鈥淚 don鈥檛 give up. My dedicated team of volunteers, and the koalas, keep me going despite huge challenges.鈥�
