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 med-
ical practitioners in innovative methods to treat and cure 
hydrocephalus, to fund related research, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘International Hydro-
cephalus Treatment and Training Act’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Hydrocephalus, also known as ‘‘water on 
the brain’’, is a medical condition in which an abnor-
mal accumulation of cerebrospinal fluid in the ven-
tricles or cavities of the brain causes increased 
intracranial pressure inside the skull and progressive 
enlargement of the head. 
(2) If left untreated, hydrocephalus leads to 
physical and mental disabilities and eventually 
death. 
(3) Hydrocephalus is an extremely painful con-
dition that most commonly occurs in infants and 
young children as a result of a congenital abnor-
mality (anatomic abnormality, aqueductal stenosis, 
spina bifida or encephalocele), or post-infectious hy-
drocephalus (PIH) caused by infections acquired 
after birth, such as meningitis, that attack the 
brain. 
(4) PIH is the most common cause of hydro-
cephalus globally, accounting for approximately 60 
percent of all cases. 
(5) Three to five out of every 1,000 newborns 
in developing countries are either born with hydro-
cephalus or acquire it due to neonatal infections in 
the first few months of life. 
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(6) It is conservatively estimated that more 
than 300,000 children are born with or acquire hy-
drocephalus in the developing world each year. 
(7) Children with hydrocephalus who are not ef-
fectively treated or who are not treated in the early 
stages of the condition suffer from cognitive defi-
ciencies or physical disabilities or both. 
(8) Families of children who have hydro-
cephalus in developing countries rarely know that it 
is a treatable condition, where to go for treatment, 
or how to care for a child suffering from the condi-
tion. 
(9) Many children with hydrocephalus in devel-
oping countries are abandoned, ostracized, or abused 
due to their appearance and physical and mental 
disabilities. 
(10) Hydrocephalus can be treated, and ad-
vances in innovative medical procedures such as 
ETV/CPC have the potential to save thousands of 
lives annually and prevent or mitigate physical and 
mental disabilities in thousands of children in devel-
oping countries. 
(11) The current standard treatment for hydro-
cephalus is the VP shunt which often requires up to 
5 surgical revisions before a child reaches adulthood 
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to remedy blockages in the shunt and to account for 
the child’s growth. Blockages can be expected during 
the life of the patient and can lead to death, particu-
larly in developing countries where access to the req-
uisite medical expertise often is not available. 
(12) Due to the need for multiple replacements 
of a VP shunt, this treatment is expensive and cre-
ates an increased burden on fragile health systems, 
patients, and families. 
(13) ETV/CPC is a shunt-less surgery for hy-
drocephalus that does not require a VP shunt and 
has been shown to be appropriate in at least two- 
thirds of the cases of infants with hydrocephalus. Of 
those cases, ETV/CPC is 93 percent effective in 
eliminating hydrocephalus. 
(14) Few hospitals with the expertise and ca-
pacity to treat hydrocephalus exist in developing 
countries, and the demand for treatment far exceeds 
the capacity of health systems in those countries. 
(15) Neurosurgical care for hydrocephalus in 
developing countries is widely unavailable due to a 
lack of trained neurosurgeons. In East Africa, there 
is only 1 neurosurgeon per 10,000,000 people. In 
many developing countries there are no trained neu-
rosurgeons. 
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(16) Hundreds of thousands of cases of hydro-
cephalus in children in developing countries could be 
successfully treated if adequate resources are de-
voted to training surgeons in new techniques, such 
as ETV/CPC, and many future cases could be pre-
vented if adequate resources are devoted to research 
means to mitigate the preventable causes of hydro-
cephalus. 
(17) Adoption of innovative new techniques to 
treat hydrocephalus, such as ETV/CPC, are more 
cost effective in the long term than current treat-
ment methods since only one surgery is required in 
most cases, thus limiting the impact on overbur-
dened health systems in developing countries. 
SEC. 3. ASSISTANCE TO TREAT HYDROCEPHALUS AND 
TRAIN SURGEONS. 
Chapter 1 of part I of the Foreign Assistance Act 
of 1961 (22 U.S.C. 2151 et. seq.) is amended— 
(1) by redesignating the second section 135 (as 
added by section 5(a) of the Senator Paul Simon 
Water for the Poor Act of 2005 (Public Law 109– 
121; 119 Stat. 2536)) as section 136; and 
(2) by adding at the end the following: 
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‘‘SEC. 137. ASSISTANCE TO TREAT HYDROCEPHALUS AND 
TRAIN SURGEONS. 
‘‘(a) PURPOSES.—The purposes of assistance author-
ized by this section are— 
‘‘(1) to ensure that life-saving treatment of hy-
drocephalus is an important priority of United 
States bilateral foreign assistance, including through 
promotion of innovative treatments and training of 
medical practitioners from the developing world in 
the latest treatment protocols and best practices for 
the treatment of hydrocephalus, including— 
‘‘(A) surgery and post-surgery care in de-
veloping countries; 
‘‘(B) the creation of a comprehensive hy-
drocephalus training program based in the de-
veloping world for surgeons and key members 
of their medical team; and 
‘‘(C) the training of medical practitioners 
based in the developing world in ETV/CPC and 
other appropriate treatment protocols; and 
‘‘(2) to promote research to reduce the inci-
dence of PIH epidemiology, pathophysiology, and 
disease burden, and to improve treatment of hydro-
cephalus. 
‘‘(b) AUTHORIZATION.—To carry out the purposes of 
subsection (a), the President is authorized to provide as-
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sistance to support a network of trained medical practi-
tioners to treat hydrocephalus in children at pediatric hos-
pitals and hydrocephalus treatment centers in developing 
countries with a high incidence of hydrocephalus. 
‘‘(c) ACTIVITIES SUPPORTED.— 
‘‘(1) COMPREHENSIVE PROGRAM.— 
‘‘(A) IN
GENERAL.—Assistance provided 
under subsection (b) shall, to the maximum ex-
tent practicable, be used to establish a com-
prehensive program to administer global hydro-
cephalus treatment and training activities uti-
lizing a network of pediatric hospitals capable 
of performing endoscopic surgery in developing 
countries. 
‘‘(B) ADMINISTRATION.—The program de-
scribed in subparagraph (A) shall be adminis-
tered by healthcare executives and neuro-
surgeons with expertise in the treatment of hy-
drocephalus. 
‘‘(C) RESPONSIBILITIES.—The responsibil-
ities of the administrators described in subpara-
graph (B) shall include— 
‘‘(i) developing an appropriate edu-
cation and training curriculum; 
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