For most Ugandan citizens, life can be difficult. A majority of the nation’s 28 million people live well bellow the poverty line with little access to quality health care. As a poverty-stricken nation with a birth rate four times higher than the United States, pediatric medical conditions like hydrocephalus, a fairly common condition, are a very serious concern.
Hydrocephalus is a build up of fluid in the brain, which can lead to extreme enlargement of the head in infants, progressive brain damage, and eventual death as the baby grows older. In resource-poor countries like Uganda it’s commonly caused by neonatal infection. The condition is
It’s a daunting problem, but Benjamin Warf, MD, director of Neonatal and Congenital Anomalies Neurosurgery in the Department of Neurosurgery at Children’s Hospital Boston, has developed an innovative surgical technique that has been successful in decreasing the number of hydrocephalus deaths in developing countries like Uganda.
Warf has been performing neurosurgeries in Uganda for 10 years, including a six-year stint where he, his wife and their six children moved to the African country to help establish a pediatric neurosurgery hospital in conjunction with Cure International, an organization that helps provide medical treatment in developing nations. As the hospital’s medical director, Warf performed thousands of neurosurgeries on Ugandan children while teaching many local doctors the latest neurosurgical techniques.
While teaching, Warf and his colleagues spent a majority of their time treating children for hydrocephalus. The standard treatment for the condition involved implanting drainage tubes called shunts in the fluid spaces of the brain so the excess cerebrospinal fluid could be absorbed into the body. The shunt implant operations were successful, but the shunts proved problematic because they required continual upkeep and medical supervision afterwards due to their propensity for failure throughout the patient’s life.
Even with constant monitoring, most shunts will fail at some point, requiring immediate to treatment to avoid death. But in sub-Saharan Africa, a poor and war-torn area with approximately one neurosurgeon for every 10 million people, treatments requiring extensive post-operative care aren’t nearly as practical or safe as they are in other parts of the world.
“There are almost a quarter million infant cases of hydrocephalus in Africa every year. Based on surgeon availability that would mean each neurosurgeon would have to treat a couple thousand cases annually, including follow-up treatment,” Warf says. “And then they wouldn’t have time for treating anything else. There’s just not enough access to care for that to be feasible.”
In response, Warf and his team developed a minimally invasive surgical technique that prevents the need for shunts in most children. During the procedure, an opening is created inside the brain that allows the trapped fluid to escape, and then part of the tissue that produces the fluid is cauterized. This safely reduces the problematic buildup and negates the need for the sometimes unreliable shunts. Thus far it’s been highly successful; more than half of infants who receive the surgery are cured without requiring continued treatment.
Based on these numbers— and important connections he’s made in the African medical community—Warf may soon be able to do even more to prevent hydrocephalus deaths in Africa. The doctor has recently been in talks with the Ministry of Health of Rwanda, a nation eager to improve its medical care, about helping them develop pediatric surgical care for their country.
Though early in the concept stage, Warf is hopeful the partnership could one day provide cutting edge training and technology to African doctors while possibly giving Children’s employees a unique opportunity to teach and treat people on the other side of the world. “Over time I think it could be a great opportunity to help develop pediatric surgical services for the whole region,” he says. “I’m excited to be a part of it.”