Neuroscience In Africa - Times Higher Education

“My master’s thesis looked at the workof artists Zanele Muholi and NicholasHlobo and investigated the assumptionthat homosexual and transgenderidentities are unAfrican.” Bothphotographer Zanele Muholi and sculptorNicholas Hlobo confront stereotypes ofgender and sexuality in their work.Makhubu went on to complete a PhDin art history. “I became interested in themedium of film and video, so I travelledto Lagos – home of the Nollywood filmindustry. There I explored the ways artistslike Peter Hugo and Zina Saro-Wiwa,artists working in film and video, areresponding to the Nollywood medium.”Makhubu also became fascinatedwith the many ways that citizenship isarticulated in post-colonial Africa.“For example, in the wake of the statebroadcaster’s decline in Nigeria in thelate ’90s, the film industry sprang up inpart thanks to investment fromevangelical mega-churches.“These mega-churchesact as proxies for the state insome ways. They offer manyof the social services normallyprovided by the state –housing, health care, bankingand childcare – while requiringmembers to pay tithes,analogous to state taxes.”Nomusa Makhubu,In Living Colour 1 (2014)exploring what itmeans to be African6The idea of African-nessAfter completing her undergraduatestudies, Makhubu’s first body of workinvestigated colonial photography. “Iquestioned the way that such imagesare presented as documentary in naturewhile in fact they are highly subjectiveand were mostly shot in a studio setting.”Although the work was well received,when Makhubu was given the chance tocomplete her master’s in art history, shejumped at it. Even at that early stage,she was fascinated with the idea of whatconstitutes African-ness.PHOTOGRAPH: LIBBY YOUNG“When I finished high school, I hadgood grades, and I could have followeda career in the sciences. But I had an ‘A’in art and a keen interest in what I coulddo with it.”“I am fascinatedby the question ofwhat it feels like whenyou have been soprofoundly displacedfrom a place andyet you identifywith nothing else.”On bordersand belongingDr Nomusa Makhubu’s work encompasses academic research andthe visual arts – photography and film, in particular – to exploreideas of gender, citizenship and what it means to be African.oday, Makhubu is an awardwinning artist and a seniorlecturer in art history at theUniversity of Cape Town (UCT).Among her many accomplishments, sheco-curated South Africa’s presentation atthe Venice Biennale with Nkule Mabaso,also based at UCT, earlier this year.But she could easily have ended up asan architect or medical doctor.“Wakanda, as it is presented in thefilm, is a fictional kingdom populatedby five tribes brought together bythe mineral wealth of [the fictional]‘vibranium’. South Africa on the otherhand is settled on gold, diamonds,platinum, chromium and uranium. Andit is known for its arrogance about itsminerals, judicial system, technologiesDuring 2014, Makhubu joinedthe Michaelis School of FineArt at UCT as a lecturer in arthistory. Her research interestshave continued to includethemes of citizenship and theartificiality of the nation state.When she was asked tocontribute to a roundtableabout the film Black Panther, she chosethe borders of Wakanda as her subject.“The spatial politics of Wakandaas a place are very interesting,” shesays. “In the paper, I make an analogybetween Wakandan and South Africanexceptionalism.”and so on, and the assumption that itwill never spiral into the civil war, povertyor political and socio-economic demisethat other African countries faced in the1980s.”Makhubu also considered the filmin relation to other black superheroes,including those that came before: thegenre of Nigerian comics that combineelements of African cosmologies andAfrotopian themes; the South Africanfilm Ikati Elimanyama (isiZulu for “BlackCat”); and the black township comicbook superhero, Kwezi.But Black Panther, she says, was thefirst such offering from a mainstreamentertainment giant like Marvel to probedifficult questions pertinent to Africaand Africans, such as about panAfricanism, black nationalism and thetransatlantic trauma of displacementthrough slavery.Art interventionismMakhubu is working on a book aboutunconventional African art forms andthe role of art interventionism in socialengagement. “By interventionism, I meanthat by doing something unconventionalyou are messing with the normand going against the grainin terms of what is considereddecorous and what is thoughtof as obscene.“These are works that areoften informal, disruptive andtemporary, and that focus onthe strong symbolic codesoften used in public and urbanspaces. These are works thatcan’t easily be categorised,sold or archived,” she explains.“Some examples includeperformance art and graffitior the art collective that puta portable toilet into a CapeTown gallery space.”Makhubu plans to continueto explore ideas of belongingand displacement in her futureresearch. “I am fascinatedby ideas of ‘uncitizening’ inAfrica and the question of what it feelslike when you have been so profoundlydisplaced from a place and yet youidentify with nothing else.“What does the idea of ‘nation state’mean at this point in time? And whatdoes the signifier ‘African’ stand for?”umthombo 7

SPOTLIGHTNEUROSCIENCENeurosciencein AfricaPHOTOGRAPH: KARIN SCHERMBRUCKER/SLINGSHOTMEDIA.CO.ZAExploring the human brain and meeting neurohealth challenges in Africa is the goal of theUniversity of Cape Town’s new NeuroscienceInstitute, designed to be comprehensive innature and cross-cutting in function. It doesthis by drawing together expertise acrossneurosurgery, neurology, psychiatry,imaging, genetics and neuroscience.8Lindizwe Dlamini, UCT PhD candidatein neuroscience, processes blood forresearch into traumatic brain injuryled by Professor Tony Figaji in thePaediatric Neurosurgery Unit.umthombo 9

SPOTLIGHTNEUROSCIENCEFROM LEFT TO RIGHT A thin sliceof brain from a genetically modifiedmouse with different components ofthe neurons visible in green and red;Amalia Awala, a UCT postgraduateresearcher in neuroscience; UCTneuroscientist Dr Joseph Raimondooperating a precision microscope; ablue-stained human pyramidal neuron,a type of large neuron named for itstriangular cell body.Brain gainThe University of Cape Town (UCT) Neuroscience Institute isdesigned to be comprehensive and cross-cutting, making it possiblefor experts in diverse fields to come together to better understandAfrican challenges: the interplay between the brain and conditionslike trauma and infection, and its consequences.In 1979, former UCT professor andphysicist Allan Cormack won the NobelPrize in Medicine for inventing CT(computerised tomography) scanning.Now, 40 years later and in the samebuilding where Cormack did hisresearch, there is an institute dedicatedto the human brain.The director of the UCTNeuroscience Institute and MauerbergerChair of Neurosurgery, ProfessorGraham Fieggen, is a passionateadvocate for, in his words, “doing awaywith false compartmentalisation when itcomes to the human brain”.“While there has been a tendencyfor clinicians and researchers to getstuck in the perspective of theirtraining – whether that was neurology,neurosurgery or psychiatry – it isimportant to remember that we are all10treating the same brain,” he says.“It is therefore essential to give thenext generation of specialists a muchbroader understanding of the brain.”According to Fieggen this is oneof the characteristics which sets theNeuroscience Institute apart from othersuch facilities. “Having a centre whichoffers truly multi-disciplinary trainingand the chance for patients to beassessed in a holistic way is very excitingand a first for Africa.”Matthew Wood, a UCT alumnusand professor of neuroscience at theUniversity of Oxford, believes that theinstitute is unique. “It combines clinicalexcellence with deep expertise in majorareas of neuroscience, such as braininfections, which are a high priorityfor African and developing-worldpopulations.“This, coupled with a special focuson paediatric populations, means thatthe Neuroscience Institute will, in time,make a powerful contribution to globalneuroscience.”Breadth of brain researchAnother defining characteristic of theNeuroscience Institute is the scopeof its research. In addition to offeringa postgraduate programme andspecialised professional training, theinstitute’s members are involved inbroad-ranging research related to thebrain.“There is a huge array of work beingdone: in the community and clinicsthrough to operating theatres andthe laboratory,” says Fieggen. “Thesevary greatly: from a multi-year study of1 000 mother-child pairs to intensivePHOTOGRAPHS: TARIRO CHATIZA, THIJS VERHOOG, KARIN SCHERMBRUCKER/SLINGSHOTMEDIA.CO.ZAAn African instituteof excellencemonitoring of the brain to improverecovery from injury and developmentof new surgical techniques. Oneexample is work done by ProfessorDarlene Lubbe and her team at GrooteSchuur Hospital to access brain tumoursvia the eye-socket.”Other areas in which the Institutehopes to build on a strong researchfoundation are neuro-infection –diseases that affect the nervous system,such as meningitis and encephalitis –and early brain development.UCT Professor Kirsty Donald, deputydirector of the Neuroscience Institute,explains that explosive populationgrowth in Africa could mean that by2050 a large part of the population willbe younger than 18 years.“This growth represents hugepotential,” says Donald, a paediatricneurologist. “But it also means that wemust urgently understand how best tosupport healthy brain development inchildren, particularly those children wholive in high-risk contexts and places inwhich they are exposed to infectionslike HIV.“There are few places in the worldthat combine deep expertise with“It is not enough thatthe Neuroscience Institute isrelevant to today’s challengesin health care in Africa andglobally. It must also havethe capacity to answertomorrow’s questions.insight and understanding of thesepopulations.“The UCT Neuroscience Institute isone place where this is possible, thanksin part to the special relationship thatthe university enjoys with the Red CrossWar Memorial Children’s Hospital asa teaching facility. The NeuroscienceInstitute represents an enormousopportunity to improve people’s lives.”Transforming neuroscienceDr Joseph Raimondo, a UCT seniorlecturer and neuroscientist, leads theinstitute’s basic neuroscience laboratoryand convenes its honours programme.He believes that the NeuroscienceInstitute represents an opportunity toaddress the issue of transformation inthe field.“There is an urgent need fortransformation in neuroscience toensure that researchers and academicsreflect the diversity of South Africa,which will help us more easily prioritiseand address research problems relevantto our context,” he says.“The honours program inneuroscience is really the entry pointfor young South Africans interestedin a career in neuroscience research.It’s therefore crucial that we makeresources available to encourage andsupport those from under-representedbackgrounds to study neuroscienceat UCT.”“It is not enough that theNeuroscience Institute is relevantto today’s challenges in health carein Africa and globally,” concludesFieggen. “It must also have the capacityto answer tomorrow’s questions.”umthombo 11

SPOTLIGHTNEUROSCIENCEEpilepsy:a collaborative cureStep 1: DiagnosisStep 3: TreatmentMikhulu* had her first seizure when she was nine monthsold. She was referred to the UCT-affiliated Red Cross WarMemorial Children’s Hospital where she was assessed by thehead of paediatric neurology, UCT Professor Jo Wilmshurst,and her team. They diagnosed Mikhulu with epilepsy,identified the type of epilepsy affecting her and started heron medical treatment.Now five years old, Mikhulu has prolonged seizuresmany times a day. Unfortunately, three kinds of antiseizuremedication haven’t been able to control them.As part of her assessment in the neurophysiologydepartment, Mikhulu is monitored with a specialised tool thatrecords her seizures and helps doctors identify the part ofthe brain where they most likely originate. After a thorough,multi-part assessment, Wilmshurst and her team identify thecause of Mikhulu’s epilepsy and recommend her for surgery.Once the team has confirmed which part of Mikhulu’s brain iscausing her seizures, Enslin decides which surgical techniqueto use.“We decide whether we can do a surgical resection toremove the part of the brain causing her seizures – thepreferred choice – or whether we can disconnect it fromthe rest of the brain.”If neither of these techniques is appropriate, they willconsider inserting a battery-operated nerve stimulator.But in Mikhulu’s case, the team decides to remove thetemporal lobe causing her seizures. After an operation thatlasts six hours and involves multiple neurological tests, Enslinsuccessfully removes the brain tissue.Step 2: EvaluationBefore Mikhulu undergoes surgery, she is assessed byneurologists and neurosurgeon Dr Nico Enslin, who willoperate on her to isolate the part of her brain causing theseizures. She also undergoes a full neuropsychologicalassessment.12Step 4: ResearchThe piece of brain Enslin removes is about the size of amatchbox. This would normally go for routine examination,but Mikhulu and her parents have given their consent for it tobe used for research too.So, Dr Joe Raimondo and his team receive the brain tissuein the operating theatre and keep it ‘alive’ using artificialcerebrospinal fluid, a clear liquid found in the brain and spinalcord that helps to protect the brain.PHOTOGRAPH: KARIN SCHERMBRUCKER/SLINGSHOTMEDIA.CO.ZA. ICONS: SHUTTERSTOCKEpilepsy – a disorder that causes abnormal electrical brain activity leadingto recurring seizures – can affect anyone. Although daily medicationcan treat the condition, doctors are increasingly recommending surgeryas a cure for patients who don’t respond to medical treatment. A multidisciplinary team of University of Cape Town (UCT) specialists is makingsure that more and more patients with drug-resistant epilepsy are cured.“We rush it back to the lab and very finely sectionthe tissue,” explains Raimondo, who leads the basicneuroscience laboratory at UCT. “Then we use sophisticatedelectrodes and microscopes to record the activity ofindividual brain cells.“We also stain the cells to study their exquisitemorphology. This gives us valuable insight into theunique features of human brain cells and the possibleunderpinnings of epilepsy.”Step 5: Recovery1Diagnosis4ResearchMikhulu undergoes rehabilitation after which her doctors willgradually wean her off her epilepsy medication. This beginssix months after her surgery.Due to the nature of Mikhulu’s epilepsy and because shewas a well-selected candidate for surgery, she has a verygood chance of being seizure-free and off medication froma year after surgery.* While Mikhulu (meaning ‘great hope’ in isiXhosa) isnot a real patient. The case described is typical of manyundergoing neurosurgery for epilepsy.Evaluation2Treatment35Recoveryumthombo 13

SPOTLIGHTNEUROSCIENCEUCT Dr UrsulaRohlwink working inthe cutting-edge brainmonitoring researchfacility at the RedCross War MemorialChildren’s Hospital.Insidegrowingbrains14the burden in childrenDr Ursula Rohlwink joined the“They have shown that exposure to HIV can alterthe health and maturity of white matter in babies’ brains,even if they have not been infected by the virus.normal, healthy populations from birth,throughout childhood, into adulthoodand beyond,” agrees Meintjes, theSouth African Department of Scienceand Technology/National ResearchFoundation Research Chair in BrainImaging.“This allows us to establishtrajectories of normal braindevelopment and ageing – critical ifwe want to examine how disease altersbrain development and function.”Donald and Meintjes are involvedin several long-term studies lookingat how children’s brains develop –both in the womb and after birth– in the context of high-risk factorslike alcohol use, cigarette smoking,methamphetamine use, poor maternalmental health and exposure to HIV.For example, they have shown thatexposure to HIV can alter the health andmaturity of white matter – which affectslearning and brain functions – in babies’brains, even if they have not beeninfected by the virus.“It looks like this is also leadingto structural changes later on,” saysDonald.Meintjes explains that recentresearch from the Cape UniversitiesBody Imaging Centre, of which shePHOTOGRAPH: SUPPLIED“In the past, it wouldn’t havebeen ethically responsible to exposechildren to even the small amount ofradiation that CT scanners emit unlessthere was a clinical indication to doso,” explains Donald, a paediatricneurologist based at the Red CrossWar Memorial Children’s Hospital inCape Town. “But magnetic resonanceimaging (MRI) has made it possible forus to conduct this kind of research.”“One major benefit of MRI – whichis completely safe, non-invasive anddoes not involve any harmful, ionisingradiation – is that we can ethicallystudy brain development and ageing inBrain injuryand infection:PHOTOGRAPH: TINA FLOERSCH/UNSPLASHRecent growth inavailability of safe andnon-invasive techniquesfor visualising the brainhas had a huge impact onhow we study children’sbrains. UCT researchersProfessor Kirsty Donaldand Professor ErnestaMeintjes explain what theyhave learnt about howyoung brains develop inhigh-risk contexts.is director, showed that particularsupplements can help mitigate theadverse effects of alcohol exposure forbabies whose mothers consumed largeamounts of alcohol while they werepregnant. These babies grew betterand performed better cognitively if theirmothers took supplements of choline –a nutrient found in many foods.Both of these studies were madepossible by neuroimaging techniques.“Neuroimaging allows us toinvestigate relationships betweenimaging measures, such as brainvolumes, with neuropsychologicalperformance, neurocognitive function,socioeconomic measures, inflammatoryand genetic markers, microbiomediversity, et cetera,” continues Meintjes.“In the future, this will help us tofigure out the brain activity related tospecific diseases and disorders.”University of Cape Town (UCT) Divisionof Neurosurgery in 2009. Since then,her work has focused on children withtraumatic brain injury and the neuroinfection tuberculous (TB) meningitis,which comes about when the TBbacterium infects the central nervoussystem’s membranes. In 2018, she wasawarded one of the UCT NeuroscienceInstitute’s first fellowships.“Among African children, bothtraumatic brain injury and TB meningitisare associated with high rates ofdeath and illness,” Rohlwink explains.“My work addresses these two majorburdens of disease on our continent.”Although considerable research ontraumatic brain injury is being doneelsewhere, in Africa it remains a “silentdisease”, says Rohlwink. “And althoughTB meningitis is the most fatal form ofTB, little research has concentrated onthe organ of injury, the brain.“My work focuses on understandingthe mechanisms of brain injury whichare relevant to both of these conditions– and other common brain diseases– with the aim of identifying new andimproved treatment options.”Rohlwink is based in the PaediatricNeurosurgery Unit at the Red Cross WarMemorial Children’s Hospital headedby UCT Professor Anthony Figaji. Theunit embraces the strategic advantagesof its South African context: highnumbers of patients and sophisticatedmonitoring and laboratory techniques.“This has enabled me to do researchon these diseases that, on one hand,cannot easily be conducted elsewhere,and on the other, is driven by itsrelevance to patients,” she continues.“The brain is the most vital organ fora productive and full life. Ensuring thehealth of the developing brain is crucialto the future of individual children andsociety.”umthombo 15

SPOTLIGHTNEUROSCIENCEBanishingphantom painSequencingthe futureKatleho Limakatso andAssociate ProfessorRomy Parker arestudying phantom pain:a debilitating conditionaffecting seven outof

Research Fund, UCT's Professor Jean-Paul van Belle and Dr Paul Mungai (Department of Information Systems) measured digital labour platforms' levels of adherence to ve Fairwork principles: fair pay, fair contracts, fair conditions, fair management and fair representation. These include evaluating whether a company pays