,i #aacth ,,congress #ast ,session ,h4 ,r4 #cebe ,,in ,,the ,,house ,,of ,,representatives ,november #ah1 #bjac ,mr4 ,smith of ,new ,jersey introduced the following bill2 which was referred to the ,committee on ,foreign ,affairs ,a ,,bill ,to amend the ,foreign ,assistance ,act of #aifa to provide assistance for the treatment of hydrocephalus in children in developing countries1 to train surgeons and other medical practitioners in innovative methods to treat and cure hydrocephalus1 to fund related research1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,international ,hydrocephalus ,treatment and ,training ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,hydrocephalus1 also known as water on the brain1 is a medical condition in which an abnormal accumulation of cerebrospinal fluid in the ventricles or cavities of the brain causes increased intracranial pressure inside the skull and progressive enlargement of the head4 7#b7 ,if left untreated1 hydrocephalus leads to physical and mental disabilities and eventually death4 7#c7 ,hydrocephalus is an extremely painful condition that most commonly occurs in infants and young children as a result of a congenital abnormality 7anatomic abnormality1 aqueductal stenosis1 spina bifida or encephalocele71 or post-infectious hydrocephalus 7,,pih7 caused by infections acquired after birth1 such as meningitis1 that attack the brain4 7#d7 ,,pih is the most common cause of hydrocephalus globally1 accounting for approximately #fj percent of all cases4 7#e7 ,three to five out of every #a1jjj newborns in developing countries are either born with hydrocephalus or acquire it due to neonatal infections in the first few months of life4 7#f7 ,it is conservatively estimated that more than #cjj1jjj children are born with or acquire hydrocephalus in the developing world each year4 7#g7 ,children with hydrocephalus who are not effectively treated or who are not treated in the early stages of the condition suffer from cognitive deficiencies or physical disabilities or both4 7#h7 ,families of children who have hydrocephalus in developing countries rarely know that it is a treatable condition1 where to go for treatment1 or how to care for a child suffering from the condition4 7#i7 ,many children with hydrocephalus in developing countries are abandoned1 ostracized1 or abused due to their appearance and physical and mental disabilities4 7#aj7 ,hydrocephalus can be treated1 and advances 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 developing countries4 7#aa7 ,the current standard treatment for hydrocephalus is the ,,vp shunt which often requires up to #e surgical revisions before a child reaches adulthood to remedy blockages in the shunt and to account for the child's growth4 ,blockages can be expected during the life of the patient and can lead to death1 particularly in developing countries where access to the requisite medical expertise often is not available4 7#ab7 ,due to the need for multiple replacements of a ,,vp shunt1 this treatment is expensive and creates an increased burden on fragile health systems1 patients1 and families4 7#ac7 ,,etv_/,,cpc is a shunt-less surgery for hydrocephalus 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 hydrocephalus4 ,of those cases1 ,,etv_/,,cpc is #ic percent effective in eliminating hydrocephalus4 7#ad7 ,few hospitals with the expertise and capacity to treat hydrocephalus exist in developing countries1 and the demand for treatment far exceeds the capacity of health systems in those countries4 7#ae7 ,neurosurgical care for hydrocephalus in developing countries is widely unavailable due to a lack of trained neurosurgeons4 ,in ,east ,africa1 there is only #a neurosurgeon per #aj1jjj1jjj people4 ,in many developing countries there are no trained neurosurgeons4 7#af7 ,hundreds of thousands of cases of hydrocephalus in children in developing countries could be successfully treated if adequate resources are devoted to training surgeons in new techniques1 such as ,,etv_/,,cpc1 and many future cases could be prevented if adequate resources are devoted to research means to mitigate the preventable causes of hydrocephalus4 7#ag7 ,adoption of innovative new techniques to treat hydrocephalus1 such as ,,etv_/,,cpc1 are more cost effective in the long term than current treatment methods since only one surgery is required in most cases1 thus limiting the impact on overburdened health systems in developing countries4 #c4 ,assistance to treat hydrocephalus and train surgeons ,chapter #a of part ,i of the ,foreign ,assistance ,act of #aifa 7#bb ,u4,s4,c4 #baea et4 seq47 is amended-- 7#a7 by redesignating the second section #ace 7as added by section #e7;a7 of the ,senator ,paul ,simon ,water for the ,poor ,act of #bjje 7,public ,law #aji-aba2 #aai ,stat4 #becf77 as section #acf2 and 7#b7 by adding at the end the following3 #acg4 ,assistance to treat hydrocephalus and train surgeons 7a7 ,purposes ,the purposes of assistance authorized by this section are-- 7#a7 to ensure that life-saving treatment of hydrocephalus is an important priority of ,united ,states bilateral foreign assistance1 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 hydrocephalus1 including-- 7,a7 surgery and post-surgery care in developing countries2 7,b7 the creation of a comprehensive hydrocephalus training program based in the developing world for surgeons and key members of their medical team2 and 7,c7 the training of medical practitioners based in the developing world in ,,etv_/,,cpc and other appropriate treatment protocols2 and 7#b7 to promote research to reduce the incidence of ,,pih epidemiology1 pathophysiology1 and disease burden1 and to improve treatment of hydrocephalus4 7b7 ,authorization ,to carry out the purposes of subsection 7a71 the ,president is authorized to provide assistance to support a network of trained medical practitioners to treat hydrocephalus in children at pediatric hospitals and hydrocephalus treatment centers in developing countries with a high incidence of hydrocephalus4 7c7 ,activities supported 7#a7 ,comprehensive program 7,a7 ,in general ,assistance provided under subsection 7b7 shall1 to the maximum extent practicable1 be used to establish a comprehensive program to administer global hydrocephalus treatment and training activities utilizing a network of pediatric hospitals capable of performing endoscopic surgery in developing countries4 7,b7 ,administration ,the program described in subparagraph 7,a7 shall be administered by healthcare executives and neurosurgeons with expertise in the treatment of hydrocephalus4 7,c7 ,responsibilities ,the responsibilities of the administrators described in subparagraph 7,b7 shall include-- 7i7 developing an appropriate education and training curriculum2 7ii7 establishing quality control standards2 7iii7 instituting safety guidelines and standards2 and 7iv7 developing monitoring and evaluation protocols4 7#b7 ,training hospital 7,a7 ,in general ,assistance provided under subsection 7b7 shall1 to the maximum extent practicable1 be used to establish a surgeon training program within a pediatric hospital based in a developing country with a high incidence of hydrocephalus with the goal of training four surgeons annually and a total of #bj surgeons over a #e-year period to treat hydrocephalus utilizing the ,,etv_/,,cpc technique4 7,b7 ,timeline ,to the maximum extent practicable1 the surgeon training program described in subparagraph 7,a7 should be operational no later than #a year after the date of enactment of this ,act4 7,c7 ,training admissions criteria ,candidates for the surgeon training program established under subparagraph 7,a7 shall-- 7i7 have a demonstrated commitment to providing medical assistance in the developing world2 and 7ii7 certify that the candidate intends to remain and practice medicine in the developing world following completion of the program4 7,d7 ,training program methodology ,the surgeon training program established under subparagraph 7,a7 shall-- 7i7 be conducted by a neurosurgeon with a minimum of #c years of full-time operating experience in the developing world2 7ii7 be a hands-on operating room experience in the developing world2 7iii7 utilize a hydrocephalus treatment protocol with an emphasis on ,,etv_/,,cpc as the preferred treatment when medically appropriate2 and 7iv7 require that each trainee complete a minimum of #ej ,,etv_/,,cpc or ,,etv procedures and at least #be ,,vp shunt procedures4 7#c7 ,treatment centers 7,a7 ,in general ,assistance provided under subsection 7b7 shall1 to the maximum extent practicable1 be used to establish at least #bj hydrocephalus treatment centers located at public and private hospital in developing countries with a high incidence of hydrocephalus1 which shall include treatment costs1 endoscopy equipment and medical supplies necessary to provide ,,etv_/,,cpc procedures to treat hydrocephalus4 7,b7 ,staffing ,the treatment centers described in subparagraph 7,a7 shall be staffed by-- 7i7 one or more surgeons who have successfully completed the surgeon training program provided pursuant to paragraph 7#b72 and 7ii7 a patient care administrator4 7,c7 ,treatment ,the treatment centers described in subparagraph 7,a7 shall-- 7i7 provide surgery to treat hydrocephalus in children2 7ii7 perform at least #ej hydrocephalus surgeries annually including a minimum of #be ,,etv or ,,etv_/,,cpc surgeries2 and 7iii7 provide post-surgery care and support for the children treated in accordance with clause 7i74 7#d7 ,medical records and data ,assistance provided under subsection 7b7 shall1 to the maximum extent practicable1 include the maintenance of medical records which track patient care activities and information about the causes and incidence rates of ,,pih4 7d7 ,definitions ,in this section3 7#a7 ,,cpc ,the term ,,cpc means choroid plexus cauterization1 a surgical procedure to reduce the production of cerebrospinal fluid in the brain4 7#b7 ,,etv ,the term ,,etv means endoscopic third ventriculostomy1 a shunt-less surgical procedure in which an opening is created in the floor of the third ventricle of the brain allowing cerebrospinal fluid to bypass any obstruction and flow directly to the basal cisterns4 7#c7 ,,etv_/,,cpc ,the term ,,etv_/,,cpc means the shunt-less surgical method for treating hydrocephalus through the combination of ,,etv and ,,cpc surgical procedures4 7#d7 ,hydrocephalus ,the term hydrocephalus means a medical condition in which an abnormal accumulation of cerebrospinal fluid in the ventricles or cavities of the brain causes increased intracranial pressure inside the skull and progressive enlargement of the head4 7#e7 ,medical practitioners ,the term medical practitioners means physicians1 nurses and other clinicians4 7#f7 ,,pih ,the term ,,pih means post-infectious or acquired hydrocephalus which is the onset of hydrocephalus after birth due to the affects of an infection1 such as meningitis1 that has attacked the brain4 7#g7 ,,vp shunt ,the term ,,vp shunt means a ventriculoperitonea shunt which is a plastic tube that is regulated by a valve and surgically placed in a brain ventricle that allows the cerebrospinal fluid to flow out of the brain through the tube and into the patient's abdomen4 7e7 ,authorization of appropriations ,of the amounts made available to carry out this chapter for child survival and maternal health programs1 there are authorized to be appropriated to the ,president such sums as may be necessary for each of the fiscal years #bjad through #bjah to carry out this section4 4