Building neurosurgical care in the heart of Africa: One doctor’s story

by Katherine Lutz on February 4, 2011

Warf with the Ugandan hospital’s first five surgical patients

In 2000, Benjamin Warf sold his house and a small farm in Kentucky and left his position as Chief of Pediatric Neurosurgery at the University of Kentucky. After giving away most of their possessions, Warf, his six children, and his wife boarded a plane for Uganda, believing they were leaving the United States for good.

It was the beginning of an extraordinary six-and-a-half-year journey, fraught with violence, racism and difficult living conditions. Warf, at the age of 42, quickly went from being a respected neurosurgeon with many friends to being the strange white man people pointed to and laughed at on the street. But it was his life-long dream to bring high quality medical care to the developing world.

“I knew when I was a young person,” says Warf, now the director of Neonatal and Congenital Anomalies within the department of Neurosurgery at Children’s Hospital Boston, “that medical mission work was something I was meant to do.”

Warf was slated to be the director of a new pediatric hospital in Mbale, Uganda, built by the Christian non-profit, CURE International. At the time, there were no pediatric neurosurgical hospitals and few trained neurosurgeons in all of Africa – where high birth rates, poor perinatal care and very large numbers of children create an extraordinary need for qualified pediatric specialists.

When the hospital opened eight months after Warf arrived, he saw a “river of children coming through the gate.”

The obstacles to providing quality care were immense. The nursing staff were poorly trained, lacking even training in CPR or proper drug dosing. Some equipment was ancient — lacking a CT scanner, Warf “got really good” at doing cranial ultrasounds with an old obstetric ultrasound machine.

But the rewards were equally profound. There was no shortage of surgical work, and Warf also quenched his thirst for research. When the hospital received an unlimited supply of low-cost shunts, Warf performed a randomized trial and one-year follow-up with patients from the hospital, proving that the cheaper shunts – at $35 each — worked just as well as their $650 counterparts.

Warf teaches Ugandan surgeons a technique that treats hydrocephalus without shunts

It was the first of many surprising and groundbreaking studies Warf would publish based on his work at the hospital. He also developed and trialed a new, minimally invasive surgical procedure to treat infant hydrocephalus, a buildup of cerebrospinal fluid (CSF) in the brain. Shunts, the usual U.S. treatment, often fail and must be fixed quickly. But in Africa, getting back to a neurosurgeon is rarely possible. Instead, Warf’s procedure combines endoscopically reducing the tissue inside the brain that produces the fluid with another procedure called endoscopic third ventriculostomy, which creates a small opening allowing the trapped fluid to escape and to be absorbed 
normally.

Doctors at Children’s Hospital Boston are now employing this combined procedure in selected infants, allowing hydrocephalus to be treated without a shunt – and bringing a technique created from dire necessity in the developing world into high-tech Western medicine.

Living in Uganda made an indelible impact on Warf’s family. In the evenings, he read to his children over candlelight, gathered around a big table. Having less made the family closer.

There were also serious challenges. His family often had no running water, electricity or any reliable way to contact friends and family back home. There was no safety net, like decent hospitals or police. Robberies of ex-pats were frequent and violence was a constant concern. One of the family’s friends was murdered.

The transition was hardest for his daughter, Sarah, now 19 years old, who is severely affected by neurofibromatosis. In many African cultures, disability and deformity are seen as curses, and even some adults were cruel to her.

In spite of the difficulties, Warf says his time in Uganda was the highlight of his career. Now the hospital is self-sustaining, performing about 1,000 pediatric neurosurgical operations every year. The doctors he trained, including the current medical director, neurosurgeon John Mugamba, continue working at the hospital.

“I worked myself out of a job,” says Warf.

But that was the goal. “I was able to do more good there in six years than in 20 years of practice in the U.S.”

Warf’s strong ties to Uganda haven’t frayed. He returns at least once a year to train surgeons in the hydrocephalus technique and oversees research projects on a daily basis. He is collaborating with CURE International on a new venture, “CURE Hydrocephalus,” a network of hydrocephalus treatment centers in developing countries.

Though most of Warf’s children are now grown, they have never forgotten their time in Uganda. Perhaps his daughter Sarah, who attends a special needs school in Massachusetts, has benefited the most from the family’s return to the states. Her struggle to receive the proper care and treatment in Uganda mirrors the plight of the many ill and disabled Ugandan children Warf is still trying to help.

17 comments

  • Blon78

    wow! amazing.

    • Chad

      My name is Chad Stephenson and I am one of the Miracles which Dr. Warf performed before leaving the University of Kentucky and heading to Uganda.  I would love to believe that my recovery, brought forth by the carefully guided hands of His during the surgery and placement of the Shunt I have, were a part of what has led him to do what he has done.  God is AWESOME and I know, by way of what Dr. Warf told me on my one year visit when he pointed upward after I thanked him for what he had done and said “Direct your praise where it is deserved” that he feels the same way !!!

  • Sharon Donnelly

    I read this story with particular interest…My first shunt was placed by Dr. John Shilleto, in early 1962..and I’ve been the beneficiary of so many advances in neurosurgery, and am now 51 years old. How wonderful to see the wonder of the shunt being bough to areas of the world where it was previously unavailable. Bravo Dr. Warf and CURE!

    • Chad

      My name is Chad Stephenson and I am one of the Miracles which Dr. Warf performed before leaving the University of Kentucky and heading to Uganda.  I would love to believe that my recovery, brought forth by the carefully guided hands of His during the surgery and placement of the Shunt I have, were a part of what has led him to do what he has done.  God is AWESOME and I know, by way of what Dr. Warf told me on my one year visit when he pointed upward after I thanked him for what he had done and said “Direct your praise where it is deserved” that he feels the same way !!!

  • Blon78

    wow! amazing.

  • Sharon Donnelly

    I read this story with particular interest…My first shunt was placed by Dr. John Shilleto, in early 1962..and I've been the beneficiary of so many advances in neurosurgery, and am now 51 years old. How wonderful to see the wonder of the shunt being bough to areas of the world where it was previously unavailable. Bravo Dr. Warf and CURE!

  • Margie Leitner

    What an inspiring story! Kudos to Dr. Warf and family for their commitment to a wonderful cause.

    Margie Leitner

  • Margie Leitner

    What an inspiring story! Kudos to Dr. Warf and family for their commitment to a wonderful cause.

    Margie Leitner

  • http://www.facebook.com/people/John-Chen/100002077424815 John Chen

    this was real scheme for them.thank you…. for old hospital equipment contact at http://www.green4care.com

  • http://www.facebook.com/people/John-Chen/100002077424815 John Chen

    this was real scheme for them.thank you…. for old hospital equipment contact at http://www.green4care.com

  • Chad Stephenson

    Chad Stephenson posted that comment three days ago and I would LOVE to tell Dr. Warf of all which I have accomplished and how I now have a son of my own !! I would love to tell him directly how GRATEFUL I am that he allowed Him to work through him !!!!

  • Anonymous

    I would like to thank you for the efforts you have made in writing this post. I am hoping the same best work from you in the future as well. In fact your creative writing abilities has inspired me to start my own blog now.
    James Makker, MD

  • http://pulse.yahoo.com/_JUXPXN7EZZZPUUPFLVOAJWSG5Q Alexandria

    I would like to thank you for the efforts you have put in writing this blog. I am hoping the same high-grade blog post from you in the future as well.
    James Makker Neurosurgery

  • http://pulse.yahoo.com/_X64CAIKSXORZ7TDAZW2RJJM2OA Mindy

    Every week thay always have a new topic that you can discuss. I like to involve in every discussion that they have everyday in this site. Its a good discusin among the alumni.Dr. James Makker

  • Chad

    Yes, it is me Chad Stephenson again !!  I would like to add that in about 2006 my pastor left my Church in Lexington to seek other directions from God and that the intern pastor that was called in was none other then in fact, Dr. Warf’s father !!  I discovered this in that when I went up to him and asked about the same name they shared and he expressed that it was his son !!  God does work in mysterious ways doesn’t He ?

  • Ginger Brock

    My name is Ginger Brock , and for yrs Dr Warf was my Neuro at the University of KY hospital , and I had alot of complications in my younger years , I am 31 now , but if it wasnt for Dr Warf , I truely believe i would not be here today , He did my last surgery in 1999 and I do believe it saved my life.I will always be greatful to him

  • Adag-wene Richard

    wow! amazing

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