Dr. Ben Warf thought the prospects were poor that Ugandan children with hydrocephalus, or an excess of water on the brain, could be successfully treated by implanting a drainage tube. Families he cared for at a Mbale hospital had limited access to health care. A blockage in the tube, called a shunt, could be disastrous.
In the early 2000s, Warf devised an alternative that reduced the number of infants who needed brain shunts by about two-thirds. It became the standard of care at Boston Children’s Hospital, where he directs the Neonatal and Congenital Anomaly Neurosurgery Program. Now Warf is unraveling the causes of hydrocephalus, work he hopes could lead to prevention.
The 54-year-old from Lexington has been named a 2012 MacArthur Foundation Fellow, one of four Boston-area recipients of the “genius grant.” The award comes with a $500,000 stipend and, for Warf, visibility for a global health problem that he said has been “way under the radar.”
Warf grew up in the Appalachian Mountains of Eastern Kentucky, the son of a Southern Baptist pastor with a strong interest in science. He graduated from Harvard Medical School in 1984 and was drawn to pediatric neurosurgery in part by his love of children. He and his wife, Cindy, have six of their own.
The pair decided in early 2000 to act on Warf’s longtime dream of being a medical missionary. He had made some short trips to Kenya with CURE International, a Christian organization that provides surgical care in developing nations, and in March of that year the couple moved their family to Uganda, where he would help to open a hospital specializing in neurosurgery.
With high rates of childbirth, little perinatal care, and even less access to surgical specialists, Warf found the demand for his skills was high. “Immediately, it became obvious that we were going to be very busy,” he said.
Cindy Warf said her husband worried about leaving academic medicine in the United States. He thought he would have to leave his love of research behind. Instead, he found the focus of his professional life.
Warf was unhappy with placing shunts in Ugandan patients. In the United States, about half of shunts fail within two years, and some children endure scores of operations.
“We felt hard-pressed to try to avoid shunt dependence,” Warf said.
Warf tested a combination of techniques that alone had been mostly ineffective in treating infants with hydrocephalus. He cauterized tissues in the brain to slow the production of fluid and made small openings in the base of the brain to allow fluid to drain into the cavity around it. Warf and colleagues followed patients over time and found the method was effective.
Researchers have estimated that about three of every 1,000 children born in sub-Saharan Africa develop hydrocephalus after an infection. Ward knew that was the primary cause in his patients. He collected fluid samples that were tested at Pennsylvania State University and found to include bacterial DNA.
When researchers overlaid data Warf had collected with weather patterns for the region, they found that the incidence of infection rose and fell with changes in rainfall, pointing to an environmental pathogen.
Now Warf and colleagues are partnering with a hospital and medical school in western Uganda to follow mothers and babies from birth to six months of age to learn more about those who develop hydrocephalus.
“There’s a lot that we don’t know,” he said.
With funding from CURE, Warf has trained 20 neurosurgeons, mostly in Africa. They were outfitted with laptops to track their work. Warf hopes their data will provide a more global look at the condition and the various pathogens that could cause it.
The MacArthur award will further that goal, he said, allowing him to spend more time in Africa and on research projects based in the United States.