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      "title": "African imaginings: Two rivers, an unlikely ornithologist and nothing not to love",
      "body": "There are places in Africa where the thorn trees scratch at the sky on the horizon, and the sun bleeds light. White, unforgiving, heat. There are places in Africa where the more timid scrub – stubby, shy, plump with hoarded water – doesn’t dare paw at the air. It squats, fatly, in hope of rain. The rain seldom comes. \n![IMG-20180115-WA0042.jpg](https://steemitimages.com/DQmdh878VdYTtJ7ZWTdH2Z5A2wjCJtrqkEcae29HavajKon/IMG-20180115-WA0042.jpg)\nThere are places in Africa where the difference between these two cultures of plant and air is only a mountain or river. The Makuleke Region is one such place.\nScythed in two by the Luvuvhu River, the northernmost part of the Kruger National Park is home to startlingly different landscapes. On the one side of the water, white sand, chubby baobabs, and clouds which scurry with unseemly haste across the milky horizon. The only thing paler than the riverbed sand, is the expanse of sky above it. On the other, Mopani and thorn jostle for space on packed riverbeds, jabbing at the sky, as if daring it, with pokes and prods, to produce something other than further and warmer sheets of heat.\nAnd perched above a koppie, surveying it all, The Outpost Lodge.\nThe camp itself does its name justice. It is delightfully far from everything else, to which the no service signal on your cellphone attests. \nThe air is the sound of birds and baboons which yell at the horizon. The water is soft, the breeze cheeky, and the views remarkable. \n\nThe lodge’s main building emerges from the edge of a hillside. The 12 rooms (luxurious, en-suite) are scattered up the rockface, connected by a snaking Zimbabwean teak walkway. Each consists of a deck, closed on 3 sides and open to the veld below at the front. If you want, you can lower the blinds, and ensconce yourself in an expansive apartment. If you are sensible, however, you fling the curtains open (press the button which lifts the blinds), and embrace the novelty of sleeping, bathing and sun-tanning at eye level with an eagle. \nThe hours are long. The hands of the clock saunter in slow circles, affected, no doubt, buy the impressive heat. Life at the lodge follows a comforting, and agreeably lazy routine. Hosts Sandy and Mike Fennell have gone to great lengths to ensure that guests have as little to worry about – and remember – as possible whilst on holiday.\nYou are assigned a guide who attends to your every need, query and concern (largely elephant-related). They wake you at 5.30. You un-bleary your eyes, throw on some sort of clothing, and descend to the main lodge building, doing your best not to step on a dassie in the process. You’re treated to warm coffee and buttery rusks.\nYou go on a 4-hour round game drive, broken in the middle by Amarula coffee and crunchies. Breakfast is served upon your return. Then you are free to wallow in the pool (recommended) or lounge in your room and watch the storm clouds brew like weak coffee – without enthusiasm or resolution. \nAt 3.30, high tea is served, before you depart on your second 4-hour game drive, this time broken not by coffee, but sundowners. For the brief heaven when the moon and the sun share the sky, one wearing blue and the other pink, you’re treated to biltong, nuts and a g ‘n t under a baobab or at Crook’s Corner (the Confluence of Zimbabwe, Mozambique, and South Africa, as well as the Limpopo and Luvuvhu rivers).\nThe drives themselves are sublime, interesting, exciting, and – usually – bumpy. The Luvuvhu plain and the hills which surround it is the kind of place where Land Rovers are born and meet their maker. At pace, the dust on the sides of the vehicle falls into waves which mirror the ruts in the road. In low range, the tyres chew the rock which crumbles and capitulates as you lumber up the hills near fever tree forest. On the banks of the Limpopo, you sink in the sand, and then rise, slithering your way between Lala Palms and Mopani. \n\n![IMG-20180115-WA0110.jpg](https://steemitimages.com/DQma6bsZaznStkyMWM47Ptkf8t9wWrn187odGLBAPGUa76u/IMG-20180115-WA0110.jpg)\nIf you are lucky, your guide is Samuel Kapenga, self-made ornithologist, and author of an autobiography titled The Unlikely Bird Man. His smile is broad, his cheekbones high, and his hands the size of side plates. He has an encyclopaedic knowledge of the region’s birds and can name hundreds by the sound of their call alone. He can also recite their number in Robertson’s bird book, favoured habit, and quirks. The book details his journey from nightwatchman at a small school, to bird expert and esteemed tour guide.\nSamuel is a happy product of the troubled history of the region. \nThe property on which the lodge is built forms part of The Makuleke Contractual Park. The land, which was occupied by the Makuleke Community for nearly a decade and a half prior to their forced removal in the 60s, is now used for ecotourism purposes only after the awarding of a judgement which recognised the community’s rights to the land. The Makuleke Community then awarded a 30 year concession to The Outpost. The idea is that, by the end of the 30 year concession, the entire lodge will be returned to Makuleke Community to be run for their own benefit. At present, due to the concession, 10% of the lodge’s turnover goes to the community. Part of this money is available to members of the community – like Samuel – to complete training as ecotourism guides. \nAside from his exhaustive knowledge of the region’s feathered inhabitants, he is also a font of interesting facts about other animals. Don’t try to help the leopard tortoises you see crossing the roads. They carry extra water (a month’s worth) inside them. When you pick them up, they get anxious (quite reasonably), and ‘drop’ their water (pee with fright). Doves and pigeons are the only birds which can suck (go figure). Scrub hares eat their own poo (!?). He is an exceptional guide; engaging, considered, and helpful.\nThe people and the place are unparalleled.\n![IMG-20180115-WA0092.jpg](https://steemitimages.com/DQmVWsLbzgq54TgNAMfeZfgNCRPmba9pmbcq8sfz457rxZx/IMG-20180115-WA0092.jpg)\n\nIf you love baobabs more than is reasonable (as I do), and are keen to make acquaintance with the Park’s smaller game, the region is paradise and great to visit in summer. But, this season is hot. Phenomenally so. It’s the sort of uniquely sub-Saharan heat that seems to simultaneously expand and contract; pulling you out at the seams with leaching dryness and compressing you down with the force of the glare. The effect is that you’re reduced, between the hours of 11am and 4pm, to a sort of human pancake, reconstitutable only when placed in the pool, or with the addition of beer (or both). If you are after the Big 5, or do not tolerate hotness well, a winter or autumn trip is advisable – the scrub thins out so viewing is better, and the sun learns some mercy. \nAside from climatic considerations, though, there is no argument to be made against visiting. The care and consideration which go into the running of the place is considerable – from chef Johann who goes to any length to cater to picky eaters and packs lunches for guests who leave by car, to the placement of umbrellas at convenient points all around the lodge lest you get caught out-of-cover when a cloud cracks and the sky leaks hot rain. \nThe Outpost Lodge is exemplary of what happens when gems of people, place and position come together.",
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      "title": "The current that cures",
      "body": "For 79 years,  has been used to treat psychiatric illness, even though no one knew exactly how it worked. Stigmatised by scary images of the ‘shock therapy’ of the 1950s, the treatment became widely feared.\nBut doctors are finally figuring out how it functions, and the treatment no longer looks like something out of a horror film. Electroconvulsive therapy might finally shed its bad reputation.\n\n![brain.jpe](https://steemitimages.com/DQmXEfrbBDB8MpKzUjtVSX4HE1Nv8pJAdyHXK2rT3WWwaJi/brain.jpe)\n\nIT IS five-o’clock in the morning, but the clinic is already coming to life: the shuffle of efficient morning shift feet replacing the exhausted steps of the night staff. \nIn a small, neat operating room in the building’s north wing, the therapy team moves into action like a well-oiled machine.\nOutside, in the melamine-floored corridor, Nurse Sarah Bembie explains what is happening on the other side of the mint-green wall.\n“The first patient arrives before sunrise, and lies here,” says Bembie, who has been a nurse at the Cape Town psychiatric clinic for close to seven years.\nShe points to a low, railed cot lying abandoned and superfluous in the hallway.\n“Then we ask the patient: ‘Can you confirm that you have not had anything to eat for at least six hours?’, and, ‘Is all your jewellery off?’”\nIf the patient says yes to both, then their drip is inserted and anaesthetic administered. Then muscle relaxant, bite plate, and electrodes: one little suction pad connecting a wire to each temple.\n“The pads send the electricity through the patient’s brain; it’s only a weak current, but we put a bite plate in their mouth so they don’t bite themselves when they receive the shock.\n“After three minutes, it is all over,” she says.\nThen the patient is wheeled out to wake up and reorient themself in the recovery room. After an hour or so, it’s back down the hall for a normal day of group therapy and craft classes.\n“People are surprised that ECT still happens,” says Bembie. “But it’s done a lot: some of the doctors swear by it.” She shrugs. “It works.”\n\nBEMBIE IS right on both counts: ECT is still a widely-prescribed treatment for psychiatric illness, both in South Africa and globally, and many people are taken aback when they learn that this is the case.\nFirst used in the asylums of Europe, ECT was the brainchild of Professor Ladislas von Meduna, a Hungarian neurologist who observed that psychiatric patients with epilepsy appeared calmer after a seizure. \nBy 1934, von Meduna had successfully treated catatonic patients (whose ability to move and behave ‘normally’ is severely impaired) with “induced convulsions” – electric shocks.\nBut this was before the days of the anaesthesia and informed consent which are now mandatory for the use of ECT, and so von Meduna’s ‘shock therapy’ soon got a bad reputation. \nDr Janine Benson-Martin is a consultant psychiatrist at Valkenberg Psychiatric Hospital in Cape Town, and her area of research is the use of ECT in South Africa today. Benson-Martin explains that negative perceptions about the treatment are still widely held.\n“It’s definitely a barrier to patients that they think ECT is this inhumane thing that’s done when you’re still wide awake.”\nLike Benson-Martin, Dr Gerhard Jordaan, the clinical head of the psychiatric unit at Tygerberg Hospital in Bellville, agrees that people tend to assume ECT is an out-dated, brutal and “archaic” procedure.\nHowever, he explains, ECT today looks completely different from when it was first used.\n“Today, a very weak electric current is directed through the fronto-temporal areas of the brain – just above and in front of the ear – for one to two seconds, just long enough to cause a grand mal convulsion, or ‘fit’.\n“The electrode pads are either placed both on one side – in which case there is usually less short-term memory loss – or one each side of the head, which helps people more rapidly,” says Jordaan.\n“Short-term memory loss is still a side-effect, but is almost always temporary. Disorientation can arise from anaesthesia, but that doesn’t last either.\n“Today,” he stresses, “patients are always fully anaesthetised, given muscle relaxants, and have their heart-rate and oxygen-levels monitored the entire time.”\nBut, despite the fact that ECT has only been performed on anaesthetised patients since the 1960s, and muscle relaxants are used to lessen the violent convulsions (à la Jack Nicholson as R.P. McMurphy in One Few Over the Cuckoo’s Nest), negative perceptions still prevail.\n\nMARTHA MANNING, a Professor of Clinical Psychology at George Mason University in Virginia, USA, underwent ECT after battling major depression for ten years without respite. She reveals that, despite her professional qualification, she was still terrified of trying the “scary” treatment.\n“Before I went for it, I’d heard almost nothing about ECT, except for the negative images in literature and the media. The term \"shock therapy\" was scary. But I was in big trouble,” she explains.\n“Because I ‘think like a psychologist’, I’d put therapy first for years,” she says, “But I had a seven-year-old and a large family, and I felt like I had to do anything to try to stay in this world.”\nTo date, Manning has had four courses of ECT. A standard course varies between six and twelve sessions. In each session, the electrode pads (wires with ‘sucker-like’ electrodes at the end) send between 30 and 180 seconds worth of a weak electric current through the brain.\n“I felt much better afterwards,” says Manning. “It’s like the doctors on TV when they use shock pads – a defibrillator – to bring a patient back to life. It's a simplistic comparison, but one that fits for me.”\nManning has since authored Undercurrents: A Life Beneath the Surface, which chronicles her experience of ECT, and, she says, aims to dispel the perception that it still entails being handcuffed to a bed while conscious, and experiencing violent, bone-fracturing shaking. \nBut Elsabé Brits, an acclaimed science journalist from Cape Town, who, like Manning, has authored a book about living with psychiatric illness, is more moderate in her praise for the treatment.\nHospitalised in June 2001 when she began to show signs of psychiatric illness, Brits was recommended ECT when a three-week barrage of medications failed to help her brain chemicals, and thus her mood, stabilize.\n“It does work,” says Brits, “They prescribe it when your meds don’t work, or if you’re very suicidal.\n“But you have headaches. You wake up with temporary memory loss. I mean, you re-read the same magazine because you can’t remember that you’ve read it already,” she explains.\n“As I said, it helps, but ECT is quite a dramatic therapy.”\nDramatic is an accurate appraisal, and not only because ECT involves shooting electricity through the most complex and sensitive organ in the human body: it is dramatic because doctors have been using it with much success for 79 years, and only now are they beginning to surmise how it works.\n\n“AFTER THE negative perceptions people have based on what they’ve seen in movies, the next biggest barrier to people who need it having ECT, is that we weren’t sure how it works,” says Benson-Martin.\nNow, thanks to the research of Professor Andrew Leuchter and his colleagues at the University of California, this is no longer the case.\n“Over the years, our studies have led us to believe that depression is a state of increased connectivity among the various brain regions and structures,” says Leuchter, explaining that this means some parts of the clinically depressed patient’s brain are ‘hyperactive’, bombarding other brain regions with signals.\n“What treatments like ECT do is to decrease this connectivity by resetting brain activity,” he explains.\n“Our theory is that depression arises from a dysrhythmia – an abnormal network of connections that occurs in the brain. By stimulating these networks repetitively with ECT we believe that the networks will ‘reset’ to a normal configuration and the depression will resolve,” he says.\nSo, like an abnormal heartbeat can cause heart problems, which pace-makers are used to regulate, abnormal brain activity can cause depression, and that is what the ECT fixes.\nThe electric current, then, seems to repair not individual neurons, as previously guessed, but rather corrects the mechanism that regulates how the brain’s activity takes place. \nBrits and Manning agree that not knowing how ECT works made making the leap to treatment more fraught. So, with Leuchter’s discovery, psychiatrists like Jordaan and Benson-Martin believe, patients will be more inclined to give ECT a chance.\nAdd to this an awareness that the treatment has changed drastically since its inception, and ECT might finally shake off its bad reputation.",
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