if hydrocephalus is the only problem, for instance, a congenital cause of hydrocephalus and you treat the hydrocephalus early, those children can be quite normal. in a case where the hydrocephalus is secondary to another event such as an infection or hemorrhage there is sometimes varying degrees of primary brain injury like we described in the children with post infectious hydrocephalus. also, children that are shunt dependent, even in developed countries, in our own practices here in the u.s., are fortunate to have access to a safety net such that when their shunt malfunctions, they almost always have emergency access to neurosurgical care and we fix those shunts at 2:00 in the morning or whatever it takes because it is an emergency. but one of the things that drove me to look for other treatments was knowing when i put a shunt in these children and they went back to the bush, that when the shunt failed later in life, when the soft spot had closed up, they would almost certainly die before they found their way to a hospital where anybody could do anything about it. >> dr. schiff you

a common cause of hydrocephalus here is one that we never see in africa, and that is hydrocephalus secondary to hemorrhage in the brain of prematurely born infants which obviously don't survive in africa because they don't have neonatal intensive care units to keep them alive. i would like to say hydrocephalus is a disease of poverty and prosperity. there's other causes in the u.s. which are common, congenital causes, congenital obstruction of one of the pathways that the fluid has to get out, the hydrocephalus associated with spina bifoda and so forth, but what i suspect is with the high birthrates in africa, we probably see the same incidence of the other causes of hydrocephalus that we see in developed countries, and then on top of that another 60% from the upfections that we don't see at -- infections that we don't see at all here. >> actually, we -- with the sort of health care costs and in uganda and throughout the developing world, of course we know it's much higher in other places due to lack of resources and the ability of the average income of people, the level of consumer income,

i think hydrocephalus has been below the radar screen. i recently attended the world health organization. their report on disability. many things were mentioned. the infection of the children was not among the things that were talked about in the port. i think it is something that needs to be brought to the attention of the kinds of bodies that are able to find work in this area. >> i think you are doing an enormous service for those children and their families. have the gates foundation or the one campaign or the other notable charities, have they joined in? >> and not yet. with regards to the cbc, what is the acceptance of that domestically in? can you prepare the costs of shut intervention to that which you have affected and created. >> etv has been done for quite some time. it was not very successful in babies under a year of age. it was rarely done and still is not done that often. they try to avoid shut the pennants in babies from the very beginning. we added an old idea, which had been practiced a number of years ago, before shunts

this is versus about $50 for treating hydrocephalus. so we do have some hard numbers, as hard as they can get when you are working with economists. and it seems to be that there is an enormous burden and the cost benefit ratio we have determined to be a minimum of 7-1, cost to benefit, one to seven, but potentially as high as one to 50 in terms of economic benefit to society. so i think those kinds of things need to be taken into perspective when you are comparing them with the hydrofile diseases. >> thank you. dr. schiff, did you have anything to add? >> no. >> thank you very much. thank you for being here. i yield back. >> ms. buerkle, thank you very much. did you run into problems with care, international effort on hydrocephalus children in uganda. for example, was there a disbelief, a lack of buy-in from the government? or were they open to the idea when you cited your hospital there? -- sited your hospital there? >> our hospital began in 2000 and actually we were -- there's a lot of, as you can imagine, preparation done before the