text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``International Hydrocephalus 
  Treatment and Training Act''.
  
  SEC. 2. FINDINGS.
  
      Congress finds the following:
              (1) Hydrocephalus, also known as ``water on the brain'', 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 head.
              (2) If left untreated, hydrocephalus leads to physical and 
          mental disabilities and eventually death.
              (3) Hydrocephalus is an extremely painful condition that 
          most commonly occurs in infants and young children as a result 
          of a congenital abnormality (anatomic abnormality, aqueductal 
          stenosis, spina bifida or encephalocele), or post-infectious 
          hydrocephalus (PIH) caused by infections acquired after birth, 
          such as meningitis, that attack the brain.
              (4) PIH is the most common cause of hydrocephalus 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 hydrocephalus or acquire it due 
          to neonatal infections in the first few months of life.
              (6) It is conservatively estimated that more than 300,000 
          children are born with or acquire hydrocephalus in the 
          developing world each year.
              (7) 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 both.
              (8) Families of children who have hydrocephalus 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 condition.
              (9) Many children with hydrocephalus in developing 
          countries are abandoned, ostracized, or abused due to their 
          appearance and physical and mental disabilities.
              (10) Hydrocephalus can be treated, 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 countries.
              (11) The current standard treatment for hydrocephalus is 
          the VP shunt which often requires up to 5 surgical revisions 
          before a child reaches adulthood 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, 
          particularly in developing countries where access to the 
          requisite medical expertise often is not available.
              (12) Due to the need for multiple replacements of a VP 
          shunt, this treatment is expensive and creates an increased 
          burden on fragile health systems, patients, and families.
              (13) 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 
          hydrocephalus. Of those cases, ETV/CPC is 93 percent effective 
          in eliminating hydrocephalus.
              (14) Few hospitals with the expertise and capacity 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 neurosurgeons.
              (16) 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 
          techniques, such as ETV/CPC, and many future cases could be 
          prevented if adequate resources are devoted to research means 
          to mitigate the preventable causes of hydrocephalus.
              (17) Adoption of innovative new techniques to treat 
          hydrocephalus, such as ETV/CPC, are more cost effective in the 
          long term than current treatment methods since only one surgery 
          is required in most cases, thus limiting the impact on 
          overburdened 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:
  
  ``SEC. 137. ASSISTANCE TO TREAT HYDROCEPHALUS AND TRAIN SURGEONS.
  
      ``(a) Purposes.--The purposes of assistance authorized by this 
  section are--
              ``(1) to ensure that life-saving treatment of hydrocephalus 
          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 developing 
                  countries;
                      ``(B) the creation of a comprehensive hydrocephalus 
                  training program based in the developing 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 incidence of PIH 
          epidemiology, pathophysiology, and disease burden, and to 
          improve treatment of hydrocephalus.
      ``(b) Authorization.--To carry out the purposes of subsection (a), 
  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 hydrocephalus.
      ``(c) Activities Supported.--
              ``(1) Comprehensive program.--
                      ``(A) In general.--Assistance provided under 
                  subsection (b) shall, to the maximum extent 
                  practicable, 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 countries.
                      ``(B) Administration.--The program described in 
                  subparagraph (A) shall be administered by healthcare 
                  executives and neurosurgeons with expertise in the 
                  treatment of hydrocephalus.
                      ``(C) Responsibilities.--The responsibilities of 
                  the administrators described in subparagraph (B) shall 
                  include--
                              ``(i) developing an appropriate education 
                          and training curriculum;
                              ``(ii) establishing quality control 
                          standards;
                              ``(iii) instituting safety guidelines and 
                          standards; and
                              ``(iv) developing monitoring and evaluation 
                          protocols.
              ``(2) Training hospital.--
                      ``(A) In general.--Assistance provided under 
                  subsection (b) shall, to the maximum extent 
                  practicable, 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 20 surgeons over a 5-year 
                  period to treat hydrocephalus utilizing the ETV/CPC 
                  technique.
                      ``(B) Timeline.--To the maximum extent practicable, 
                  the surgeon training program described in subparagraph 
                  (A) should be operational no later than 1 year after 
                  the date of enactment of this Act.
                      ``(C) Training admissions criteria.--Candidates for 
                  the surgeon training program established under 
                  subparagraph (A) shall--
                              ``(i) have a demonstrated commitment to 
                          providing medical assistance in the developing 
                          world; and
                              ``(ii) certify that the candidate intends 
                          to remain and practice medicine in the 
                          developing world following completion of the 
                          program.
                      ``(D) Training program methodology.--The surgeon 
                  training program established under subparagraph (A) 
                  shall--
                              ``(i) be conducted by a neurosurgeon with a 
                          minimum of 3 years of full-time operating 
                          experience in the developing world;
                              ``(ii) be a hands-on operating room 
                          experience in the developing world;
                              ``(iii) utilize a hydrocephalus treatment 
                          protocol with an emphasis on ETV/CPC as the 
                          preferred treatment when medically appropriate; 
                          and
                              ``(iv) require that each trainee complete a 
                          minimum of 50 ETV/CPC or ETV procedures and at 
                          least 25 VP shunt procedures.
              ``(3) Treatment centers.--
                      ``(A) In general.--Assistance provided under 
                  subsection (b) shall, to the maximum extent 
                  practicable, be used to establish at least 20 
                  hydrocephalus treatment centers located at public and 
                  private hospital in developing countries with a high 
                  incidence of hydrocephalus, which shall include 
                  treatment costs, endoscopy equipment and medical 
                  supplies necessary to provide ETV/CPC procedures to 
                  treat hydrocephalus.
                      ``(B) Staffing.--The treatment centers described in 
                  subparagraph (A) shall be staffed by--
                              ``(i) one or more surgeons who have 
                          successfully completed the surgeon training 
                          program provided pursuant to paragraph (2); and
                              ``(ii) a patient care administrator.
                      ``(C) Treatment.--The treatment centers described 
                  in subparagraph (A) shall--
                              ``(i) provide surgery to treat 
                          hydrocephalus in children;
                              ``(ii) perform at least 50 hydrocephalus 
                          surgeries annually including a minimum of 25 
                          ETV or ETV/CPC surgeries; and
                              ``(iii) provide post-surgery care and 
                          support for the children treated in accordance 
                          with clause (i).
              ``(4) Medical records and data.--Assistance provided under 
          subsection (b) shall, to the maximum extent practicable, 
          include the maintenance of medical records which track patient 
          care activities and information about the causes and incidence 
          rates of PIH.
      ``(d) Definitions.--In this section:
              ``(1) CPC.--The term `CPC' means choroid plexus 
          cauterization, a surgical procedure to reduce the production of 
          cerebrospinal fluid in the brain.
              ``(2) ETV.--The term `ETV' means endoscopic third 
          ventriculostomy, 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 cisterns.
              ``(3) ETV/CPC.--The term `ETV/CPC' means the shunt-less 
          surgical method for treating hydrocephalus through the 
          combination of ETV and CPC surgical procedures.
              ``(4) 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 head.
              ``(5) Medical practitioners.--The term `medical 
          practitioners' means physicians, nurses and other clinicians.
              ``(6) PIH.--The term `PIH' means post-infectious or 
          acquired hydrocephalus which is the onset of hydrocephalus 
          after birth due to the affects of an infection, such as 
          meningitis, that has attacked the brain.
              ``(7) 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 abdomen.
      ``(e) Authorization of Appropriations.--Of the amounts made 
  available to carry out this chapter for child survival and maternal 
  health programs, there are authorized to be appropriated to the 
  President such sums as may be necessary for each of the fiscal years 
  2014 through 2018 to carry out this section.''.
target: International Hydrocephalus Treatment and Training Act - Amends the Foreign Assistance Act of 1961 to authorize the President 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. Requires such assistance to provide for surgeon training and establishment of at least 20 treatment centers.
feat_title: International Hydrocephalus Treatment and Training Act