There is a compelling counterpart to South Africa’s growing reputation for exploring the complexities of the outer universe with its strategic astronomy programme: an ambitious exploration of the complex internal universe of the human brain.
The brain, our most vulnerable organ, is the most complex system in the known universe. It comprises around 86 billion neurons, boasts sophisticated physiology and processes and has its own immune functioning. Its capacity to hold data is staggering: just one cubic millimetre of brain tissue can store 1.4 petabytes of information; that’s a shade less than 1.5 million gigabytes per cubic millimetre.
In children, this complexity is even more pronounced. While an adult’s brain is essentially physiologically stable, a child’s is not: it constantly undergoes rapid structural and functional changes, so much so that we cannot compare a two-year-old’s to a 12-year-old’s, let alone that of an adult.
This also means that what works in treating any brain injury in adults, including medication and surgery, is not necessarily effective in children. Indeed, trying to translate treatments is a profoundly bad idea.
We thus have a lot less understanding about traumatic brain injury and its treatment in this vulnerable patient population - children. It is well understood that brain injury in children can potentially have life-altering consequences, from learning difficulties and unemployability to behavioural issues and even criminality.
Africa, home to more children per capita than any other continent, also has the highest mortality rates for children, and brain injury is the most common cause of death and disability in otherwise healthy children on our continent. I have consequently come to believe passionately that children should be the primary focus of health research into brain injury.
Harry Oppenheimer Fellowship Award
In fact, we in Africa should be leading the world in this regard. And we will: with the R2.5-million 2024/2025 Harry Oppenheimer Fellowship Award that I have recently received, we have the opportunity to catapult Africa into the forefront of paediatric traumatic brain injury research and expertise.
We have largely already laid the foundation: at the Red Cross War Memorial Children’s Hospital in Cape Town, the first tertiary hospital in sub-Saharan Africa dedicated entirely to child healthcare, we have spent two decades building the infrastructure to manage traumatic brain injury in children. And we have spent more than a decade building up the largest physiological data set and bio-bank of samples in the world, comprising a vast trove of information that exists nowhere else.
At the hospital, we have learnt that it is imperative to treat secondary brain injury: the cascade of complex physiological events that occur as a result of an initial brain injury, aggravating the injury through swelling and lack of oxygenation, which can impact on other parts of the body. They influence each other and can create a vicious cycle that doubles and even trebles mortality.
Properly understanding how to identify and treat these secondary events is the key to substantially improving patient outcomes by as much as 50%. Not only that, it can help us to develop guidelines for institutions that don’t have sophisticated resources to easily identify and effectively respond to secondary brain injury.
Using the Harry Oppenheimer Fellowship grant, my team of interdisciplinary researchers and I will do four things:
- Analyse millions of high-frequency data points to examine advanced brain physics and physiology (like pressure, blood flow and oxygenation) to understand how the brain is disrupted and how it interacts with the rest of the body.
- Analyse the cellular changes in the brain after injury (giving rise to brain metabolism and inflammation) to better understand how this leads to the typical changes in physics and physiology of the brain after injury.
- Perform the first-ever analysis, directly in the brain, of some of the critical drugs that we use in therapies after brain injury, using a novel strategy that we developed to generate unprecedented detail of how drugs distribute in the human brain.
- Build similar research capacity at the University of KwaZulu-Natal, including setting up systems, training researchers and mentoring students and early-career researchers, to help build their standing in the international research and professional clinical community.
Ultimately, our research has three important objectives. First, we want to advance science and our understanding of the human brain, and therefore improve patient outcomes. The purpose of science is to change society for the better and, in our African context, we hold the potential to create far-reaching improvements in human health.
Second, we have a great opportunity to lead from Africa, and in the process, tell a wonderful story of academic achievement despite a dearth of the funding and academic minds that the great universities of the Global North enjoy.
Finally, this is an opportunity to create a new generation of neuroscientists right here in Africa, instead of seeing them disappear overseas. I would like to reverse that brain drain, such that scientists in search of excellence come to us – because we aim to be the best not only in Africa, but the world. DM
Anthony Figaji is director of African Brain Child and head of Paediatric Neurosurgery at the University of Cape Town and the Red Cross War Memorial Children’s Hospital, and a co-recipient of the 2024/25 Harry Oppenheimer Fellowship Award.