I 

113TH CONGRESS 

1ST SESSION H. R. 3525 

To amend the Foreign Assistance Act of 1961 to provide assistance for 

the treatment of hydrocephalus in children in developing countries, to 

train surgeons and other medical practitioners in innovative methods 

to treat and cure hydrocephalus, to fund related research, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 18, 2013 

Mr. SMITH of New Jersey introduced the following bill; which was referred 

to the Committee on Foreign Affairs 

A BILL 

To amend the Foreign Assistance Act of 1961 to provide 

assistance for the treatment of hydrocephalus in children 

in developing countries, to train surgeons and other medical practitioners in innovative methods to treat and cure 

hydrocephalus, to fund related research, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘International Hydro5 cephalus Treatment and Training Act’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Hydrocephalus, also known as ‘‘water on 

4 the brain’’, is a medical condition in which an abnor5 mal accumulation of cerebrospinal fluid in the ven6 tricles or cavities of the brain causes increased 

7 intracranial pressure inside the skull and progressive 

8 enlargement of the head. 

9 (2) If left untreated, hydrocephalus leads to 

10 physical and mental disabilities and eventually 

11 death. 

12 (3) Hydrocephalus is an extremely painful con13 dition that most commonly occurs in infants and 

14 young children as a result of a congenital abnor15 mality (anatomic abnormality, aqueductal stenosis, 

16 spina bifida or encephalocele), or post-infectious hy17 drocephalus (PIH) caused by infections acquired 

18 after birth, such as meningitis, that attack the 

19 brain. 

20 (4) PIH is the most common cause of hydro21 cephalus globally, accounting for approximately 60 

22 percent of all cases. 

23 (5) Three to five out of every 1,000 newborns 

24 in developing countries are either born with hydro25 cephalus or acquire it due to neonatal infections in 

26 the first few months of life. 


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1 (6) It is conservatively estimated that more 

2 than 300,000 children are born with or acquire hy3 drocephalus in the developing world each year. 

4 (7) Children with hydrocephalus who are not ef5 fectively treated or who are not treated in the early 

6 stages of the condition suffer from cognitive defi7 ciencies or physical disabilities or both. 

8 (8) Families of children who have hydro9 cephalus in developing countries rarely know that it 

10 is a treatable condition, where to go for treatment, 

11 or how to care for a child suffering from the condi12 tion. 

13 (9) Many children with hydrocephalus in devel14 oping countries are abandoned, ostracized, or abused 

15 due to their appearance and physical and mental 

16 disabilities. 

17 (10) Hydrocephalus can be treated, and ad18 vances in innovative medical procedures such as 

19 ETV/CPC have the potential to save thousands of 

20 lives annually and prevent or mitigate physical and 

21 mental disabilities in thousands of children in devel22 oping countries. 

23 (11) The current standard treatment for hydro24 cephalus is the VP shunt which often requires up to 

25 5 surgical revisions before a child reaches adulthood 


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1 to remedy blockages in the shunt and to account for 

2 the child’s growth. Blockages can be expected during 

3 the life of the patient and can lead to death, particu4 larly in developing countries where access to the req5 uisite medical expertise often is not available. 

6 (12) Due to the need for multiple replacements 

7 of a VP shunt, this treatment is expensive and cre8 ates an increased burden on fragile health systems, 

9 patients, and families. 

10 (13) ETV/CPC is a shunt-less surgery for hy11 drocephalus that does not require a VP shunt and 

12 has been shown to be appropriate in at least two13 thirds of the cases of infants with hydrocephalus. Of 

14 those cases, ETV/CPC is 93 percent effective in 

15 eliminating hydrocephalus. 

16 (14) Few hospitals with the expertise and ca17 pacity to treat hydrocephalus exist in developing 

18 countries, and the demand for treatment far exceeds 

19 the capacity of health systems in those countries. 

20 (15) Neurosurgical care for hydrocephalus in 

21 developing countries is widely unavailable due to a 

22 lack of trained neurosurgeons. In East Africa, there 

23 is only 1 neurosurgeon per 10,000,000 people. In 

24 many developing countries there are no trained neu25 rosurgeons. 


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1 (16) Hundreds of thousands of cases of hydro2 cephalus in children in developing countries could be 

3 successfully treated if adequate resources are de4 voted to training surgeons in new techniques, such 

5 as ETV/CPC, and many future cases could be pre6 vented if adequate resources are devoted to research 

7 means to mitigate the preventable causes of hydro8 cephalus. 

9 (17) Adoption of innovative new techniques to 

10 treat hydrocephalus, such as ETV/CPC, are more 

11 cost effective in the long term than current treat12 ment methods since only one surgery is required in 

13 most cases, thus limiting the impact on overbur14 dened health systems in developing countries. 

15 SEC. 3. ASSISTANCE TO TREAT HYDROCEPHALUS AND 

16 TRAIN SURGEONS. 

17 Chapter 1 of part I of the Foreign Assistance Act 

18 of 1961 (22 U.S.C. 2151 et. seq.) is amended— 

19 (1) by redesignating the second section 135 (as 

20 added by section 5(a) of the Senator Paul Simon 

21 Water for the Poor Act of 2005 (Public Law 109– 

22 121; 119 Stat. 2536)) as section 136; and 

23 (2) by adding at the end the following: 


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1 ‘‘SEC. 137. ASSISTANCE TO TREAT HYDROCEPHALUS AND 

2 TRAIN SURGEONS. 

3 ‘‘(a) PURPOSES.—The purposes of assistance author4 ized by this section are— 

5 ‘‘(1) to ensure that life-saving treatment of hy6 drocephalus is an important priority of United 

7 States bilateral foreign assistance, including through 

8 promotion of innovative treatments and training of 

9 medical practitioners from the developing world in 

10 the latest treatment protocols and best practices for 

11 the treatment of hydrocephalus, including— 

12 ‘‘(A) surgery and post-surgery care in de13 veloping countries; 

14 ‘‘(B) the creation of a comprehensive hy15 drocephalus training program based in the de16 veloping world for surgeons and key members 

17 of their medical team; and 

18 ‘‘(C) the training of medical practitioners 

19 based in the developing world in ETV/CPC and 

20 other appropriate treatment protocols; and 

21 ‘‘(2) to promote research to reduce the inci22 dence of PIH epidemiology, pathophysiology, and 

23 disease burden, and to improve treatment of hydro24 cephalus. 

25 ‘‘(b) AUTHORIZATION.—To carry out the purposes of 

26 subsection (a), the President is authorized to provide asVerDate Mar 15 2010 18:33 Nov 20, 2013 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3525.IH H3525

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1 sistance to support a network of trained medical practi2 tioners to treat hydrocephalus in children at pediatric hos3 pitals and hydrocephalus treatment centers in developing 

4 countries with a high incidence of hydrocephalus. 

5 ‘‘(c) ACTIVITIES SUPPORTED.— 

6 ‘‘(1) COMPREHENSIVE PROGRAM.— 

7 ‘‘(A) IN GENERAL.—Assistance provided 

8 under subsection (b) shall, to the maximum ex9 tent practicable, be used to establish a com10 prehensive program to administer global hydro11 cephalus treatment and training activities uti12 lizing a network of pediatric hospitals capable 

13 of performing endoscopic surgery in developing 

14 countries. 

15 ‘‘(B) ADMINISTRATION.—The program de16 scribed in subparagraph (A) shall be adminis17 tered by healthcare executives and neuro18 surgeons with expertise in the treatment of hy19 drocephalus. 

20 ‘‘(C) RESPONSIBILITIES.—The responsibil21 ities of the administrators described in subpara22 graph (B) shall include— 

23 ‘‘(i) developing an appropriate edu24 cation and training curriculum; 


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1 ‘‘(ii) establishing quality control 

2 standards; 

3 ‘‘(iii) instituting safety guidelines and 

4 standards; and 

5 ‘‘(iv) developing monitoring and eval6 uation protocols. 

7 ‘‘(2) TRAINING HOSPITAL.— 

8 ‘‘(A) IN GENERAL.—Assistance provided 

9 under subsection (b) shall, to the maximum ex10 tent practicable, be used to establish a surgeon 

11 training program within a pediatric hospital 

12 based in a developing country with a high inci13 dence of hydrocephalus with the goal of training 

14 four surgeons annually and a total of 20 sur15 geons over a 5-year period to treat hydro16 cephalus utilizing the ETV/CPC technique. 

17 ‘‘(B) TIMELINE.—To the maximum extent 

18 practicable, the surgeon training program de19 scribed in subparagraph (A) should be oper20 ational no later than 1 year after the date of 

21 enactment of this Act. 

22 ‘‘(C) TRAINING ADMISSIONS CRITERIA.— 

23 Candidates for the surgeon training program 

24 established under subparagraph (A) shall— 


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1 ‘‘(i) have a demonstrated commitment 

2 to providing medical assistance in the de3 veloping world; and 

4 ‘‘(ii) certify that the candidate intends 

5 to remain and practice medicine in the de6 veloping world following completion of the 

7 program. 

8 ‘‘(D) TRAINING PROGRAM METHOD9 OLOGY.—The surgeon training program estab10 lished under subparagraph (A) shall— 

11 ‘‘(i) be conducted by a neurosurgeon 

12 with a minimum of 3 years of full-time op13 erating experience in the developing world; 

14 ‘‘(ii) be a hands-on operating room ex15 perience in the developing world; 

16 ‘‘(iii) utilize a hydrocephalus treat17 ment protocol with an emphasis on ETV/ 

18 CPC as the preferred treatment when 

19 medically appropriate; and 

20 ‘‘(iv) require that each trainee com21 plete a minimum of 50 ETV/CPC or ETV 

22 procedures and at least 25 VP shunt pro23 cedures. 

24 ‘‘(3) TREATMENT CENTERS.— 


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1 ‘‘(A) IN GENERAL.—Assistance provided 

2 under subsection (b) shall, to the maximum ex3 tent practicable, be used to establish at least 20 

4 hydrocephalus treatment centers located at pub5 lic and private hospital in developing countries 

6 with a high incidence of hydrocephalus, which 

7 shall include treatment costs, endoscopy equip8 ment and medical supplies necessary to provide 

9 ETV/CPC procedures to treat hydrocephalus. 

10 ‘‘(B) STAFFING.—The treatment centers 

11 described in subparagraph (A) shall be staffed 

12 by— 

13 ‘‘(i) one or more surgeons who have 

14 successfully completed the surgeon training 

15 program provided pursuant to paragraph 

16 (2); and 

17 ‘‘(ii) a patient care administrator. 

18 ‘‘(C) TREATMENT.—The treatment centers 

19 described in subparagraph (A) shall— 

20 ‘‘(i) provide surgery to treat hydro21 cephalus in children; 

22 ‘‘(ii) perform at least 50 hydro23 cephalus surgeries annually including a 

24 minimum of 25 ETV or ETV/CPC sur25 geries; and 


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1 ‘‘(iii) provide post-surgery care and 

2 support for the children treated in accord3 ance with clause (i). 

4 ‘‘(4) MEDICAL RECORDS AND DATA.—Assist5 ance provided under subsection (b) shall, to the 

6 maximum extent practicable, include the mainte7 nance of medical records which track patient care 

8 activities and information about the causes and inci9 dence rates of PIH. 

10 ‘‘(d) DEFINITIONS.—In this section: 

11 ‘‘(1) CPC.—The term ‘CPC’ means choroid 

12 plexus cauterization, a surgical procedure to reduce 

13 the production of cerebrospinal fluid in the brain. 

14 ‘‘(2) ETV.—The term ‘ETV’ means endoscopic 

15 third ventriculostomy, a shunt-less surgical proce16 dure in which an opening is created in the floor of 

17 the third ventricle of the brain allowing cerebro18 spinal fluid to bypass any obstruction and flow di19 rectly to the basal cisterns. 

20 ‘‘(3) ETV/CPC.—The term ‘ETV/CPC’ means 

21 the shunt-less surgical method for treating hydro22 cephalus through the combination of ETV and CPC 

23 surgical procedures. 

24 ‘‘(4) HYDROCEPHALUS.—The term ‘hydro25 cephalus’ means a medical condition in which an abVerDate Mar 15 2010 18:33 Nov 20, 2013 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3525.IH H3525

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1 normal accumulation of cerebrospinal fluid in the 

2 ventricles or cavities of the brain causes increased 

3 intracranial pressure inside the skull and progressive 

4 enlargement of the head. 

5 ‘‘(5) MEDICAL PRACTITIONERS.—The term 

6 ‘medical practitioners’ means physicians, nurses and 

7 other clinicians. 

8 ‘‘(6) PIH.—The term ‘PIH’ means post-infec9 tious or acquired hydrocephalus which is the onset 

10 of hydrocephalus after birth due to the affects of an 

11 infection, such as meningitis, that has attacked the 

12 brain. 

13 ‘‘(7) VP SHUNT.—The term ‘VP shunt’ means 

14 a ventriculoperitonea shunt which is a plastic tube 

15 that is regulated by a valve and surgically placed in 

16 a brain ventricle that allows the cerebrospinal fluid 

17 to flow out of the brain through the tube and into 

18 the patient’s abdomen. 

19 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—Of the 

20 amounts made available to carry out this chapter for child 

21 survival and maternal health programs, there are author22 ized to be appropriated to the President such sums as may 

23 be necessary for each of the fiscal years 2014 through 

24 2018 to carry out this section.’’. 

Æ 


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