dr. warf has earlier today, and will say in his testimony, the number is about one per 10,000 africans. there's such a dearth of this very important and needed specialty. another major difference between the united states and sub-saharan africa is the technology employed to treat. in the western world, doctors insert a shunt into the brain in order to brain the fluid through the neck and into another part of the body where the flood to be absurded. a shunt is only temporary, and there's a danger that any one of a number of things can go wrong. for example, the tube may become blocked and infection. catheters may break or malfunction due to calcification or the valve may brain too much or too little fluid. half of all cases, shunts fail within the first two years. when they do, the patient must have immediate access to a medical facility and a doctor who can correct the problem. this prochaos situation is a concern of stress for people in the united states who suffer from hydrocephalus in their

dr. warf, if you could proceed. >> thank you very much, chairman smith, congressman payne, members of the committee. it's a great honor to be here today. i appreciate the opportunity to testify about this devastating condition affecting millions of babies in africa and across the developing world. i'm currently at children's hospital, boston, an associate professor of surgery at harvard medical school. but from 2000 to 2006, my family lived in uganda as medical missionaries to help start a specialty hospital for mediate rick neurosurgery. from its opening, our hospital was inundated with a steady stream of mothers seeking treatment for their enfants with hydrocephalus, a condition in which the fluid is unable to circulate out of the brain and be absorbed normally. this leads to rapid expansion of the infant's head, damage to the infant's brain and death if untreated. astonished by the staggering volume of patients we were presented with two questions. one, what were the chief causes and burden

we are -- we have found partnerships to allow us to go forward with training when dr. warf was there and it continues on with dr. john mugamba, his successor, as well. we are eager to do what is the most effective and efficacious manner going forward. it is a difficult thing to ask for a substantial amount of money at this point in time, but we think and we believe and we feel it is strong evidence that it is well spent and it brings value beyond its numbers. we also concur with those that have come out recently earlier this year that have noted that the public health emphasis on prevention, which is absolutely needed, needs to be balanced with those efforts to create better abilities, better capacity, i should say, for technology and for surgery that is wanting in areas. because that is a hard price to pay no matter what the economy is. >> thank you. doctor warf. >> thank you very much. i can actually give a few comparative numbers that might help put things into perspective a little bit. this is from a study that's in the press through our harvard medical school departmen