Karachi, Pakistan — Every morning in Karachi’s Safari Park, 22-year-old caretaker Ali Baloch starts his day before the sun rises. He stews rice and lentils, blends them with sugarcane molasses, and rolls the mixture into dozens of soft feed balls — each one stuffed with bitter tuberculosis pills.

Exactly 400 pills a day.

The medicine is for Malika and Madhubala, Karachi’s last two African elephants, both silently battling tuberculosis in a treatment plan that is as intense as it is extraordinary.

It can easily be called one of the most ambitious wildlife health interventions in Pakistan’s history.

“Yes, the dose is heavy,” Ali says. “But like our family members, they need special care and attention. They have emotions too — and now we’ve formed a bond.”

A rare medical mission

Diagnosed in early 2025, the elephants are undergoing a year-long treatment for TB, a disease endemic in Pakistan but rarely detected in animals.

The diagnosis was done after samples were taken by a team from an animal welfare organisation called Four Paws International.

The samples were tested at a leading private hospital in Karachi. Testing for tuberculosis is standard practice based on close contact with an infected patient.

The pills are the same used for humans, only adjusted to match the massive weight of the 4,000-kilo each elephant.

“Giving TB treatment to elephants is always challenging,” Sri Lankan vet Dr Buddhika Bandara, who flew to Karachi to lead the effort, told AFP.

He visited Pakistan from May 1 to 17 and is due to return for another round of evaluation after three months.

“But the animals have gradually adapted to the procedure.”

The plan is the result of extensive coordination, led by the Karachi Metropolitan Corporation and an 18-member technical committee on TB, which includes infectious disease experts from the Indus Hospital in Karachi, senior vets, wildlife specialists and support staff.

While tuberculosis in elephants is rare, it has been documented in captive populations in South and Southeast Asia. The disease is often contracted from humans.

“The relevant authorities have been extremely gracious in extending support,” Yusra Askari, co-secretary of the technical committee on TB, told TRT World.

“Despite the odds, we’ve managed to bring together the best possible expertise — both local and international — to ensure Malika and Madhubala receive the care they need.”

An unlikely alliance

The treatment is being supported by the Sindh government and the National TB Programme, with protocols in place to protect the humans working around the infected animals.

“Following the diagnosis, 11 staff underwent TB testing — all were cleared,” Askari told TRT World.

“Now, routine monitoring, PPE use, and distancing measures have been implemented to protect our invaluable support staff.”

The team of four mahouts (elephant caretakers) wear face masks and scrubs when feeding the elephants to avoid contracting a disease that infects more than 500,000 humans a year.

These staff — especially Ali and the other mahouts — are the backbone of the operation. They not only administer the medication; they also maintain a daily relationship with the elephants that makes the treatment possible.

“In the beginning, it was difficult,” Ali recalls. “They resisted, even charged. But now it’s part of the routine. I think they trust us.”

Hope after heartbreak

The treatment comes after years of controversy surrounding the welfare of elephants in Pakistan.

Noor Jehan, another elephant at the Karachi Zoo, died in 2023 after international outcry, including from American singer Cher.

Later, Sonia, one of the four elephants originally brought from Tanzania in 2009, also died — a post-mortem revealed TB.

Now, Malika and Madhubala are the last two left, and their recovery is being watched closely.

“Public awareness around animal welfare has changed significantly,” says Askari. “People in Pakistan are increasingly conscious of how animals are treated — and want to be part of that change.”

South Asian solidarity

The treatment plan was developed in close consultation with Sri Lankan experts, who’ve led similar recoveries in the region.

Askari believes this cooperation is an example of regional collaboration at its best.

“We are extremely grateful to Dr Rajapaksa, Dr Bandara, and our friends in Sri Lanka,” she says.

“This kind of collaboration is something we hope to build on, because we have so much to learn from and support each other with.”

A story bigger than two elephants

The case is more than a medical curiosity. It’s a live example of One Health — the concept that human, animal, and environmental health are interconnected.

With zoonotic diseases like TB, cross-species care becomes not just compassionate but necessary.

“This case has opened the door to new learning,” says Askari.

“It’s being followed by students, doctors, and conservationists — everyone is watching what’s possible when you put care, coordination, and science to work together.”

‘They know we care’

At the heart of it all is Ali, who now knows every wrinkle and habit of the elephants under his care.

“Like humans, they need love and consistency. They know we care.”

With 10 more months to go in their recovery, the road is long — but not lonely.