1: What are you trying to accomplish?
2: What's your evidence that you can accomplish it?
3: How is it possible that you can provide an open heart surgery in Iraq for less than $1,000? Is that the full cost?
4: So is that the same thing as saying that my donation doesn't really make a difference? That the "up to 85%" funded locally by those inside Iraq is all that is really necessary to make this work?
5: Any other costs?
6: What is the bottleneck to more surgeries: money or skilled labor?
7: I'm skeptical of non-profits and charities because they always seem to be asking for more money. How can I be sure that Preemptive Love Coalition has "room for more funding" and that I'm not paying into a huge savings account, "Rainy Day Fund", or something similar?
8: Do you have enough volunteer surgeons available for unfunded Remedy Missions? (i.e., are there trips that you could fund if you had more money, or is there a labor bottleneck?)
9: Many heart surgeries require follow-up treatment (including additional surgeries). Do you have a way of providing these to patients?
10: How do you assess whether surgeries are completed competently and appropriately?
11: What is the rate of complications during and following surgery?
12: How do you assess whether surgeons are performing additional surgeries that they would have not had the funding or motivation to perform otherwise?
13: How do you assess whether surgeons are charging their patients for the surgeries you fund?
14: Do you follow up with the surgeons you've trained to assess whether they are correctly applying their training?
15: What information is available on the activities - and competence - of the surgeons you've trained?
16: Where do surgeons work after completing training? Do they serve poor patients?
17: How much do you spend each year on "program" expenses and how much on "overhead?"


----------

 Q: What are you trying to accomplish?

A: Train Iraqi heart surgeons and nurses so they can eradicate the backlog of tens of thousands of Iraqi children waiting in line for lifesaving heart surgery. [Back to Top]

 Q: What's your evidence that you can accomplish it?

A: Each year we continue to increase Iraq's total number of pediatric cardiac surgeries with new surgeries in Iraqi centers that would not - indeed could not - have been accomplished otherwise. Ministry of Health (MOH) officials speculate 500 surgeries were accomplished in 2009 (of which we provided 23 - 4.6% - outside the country). The addition of our 82 surgeries in FY 2010 - to the 500 baseline - for a total of 582 approximated surgeries, represents an increase created by PLC of 14% over 2009. In FY 2011 we anticipate increasing Iraq's total number of pediatric cardiac surgeries to at least 719 (or another 19% over FY 2010 directly attributable to our surgeons and our training).

Each year the local teams with which we work will become more proficient, and each year they will independently take on a larger case load than they could have the year before. None of these figures yet account for that additional output.

In March 2010 the Iraqi Ministry of Health asked us to expand our work to three additional sites. In May 2010 we began additional discussions about establishing a fellowship program in which international surgeons and nurses would take up residence in the Iraqi system to train locally for 40 weeks out of the year.

Our model does not rely strictly on volunteers because the level of need in Iraq outstrips what we could reasonably supply through volunteer labor alone. Accordingly, we set our budgets so as to actually contract the international surgical and nursing staff we need to accomplish our mission.

Sure, this increases the cost-per-mission (and thereby, cost-per-child) over early "mission" models in which volunteerism was idealized and training was not necessarily prioritized. But our contract labor + volunteerism model is inarguably the only way to create a nationwide quarterly training program and fellowships inside Iraq with international experts across approximately 6-8 surgical sites. Moreover, our model does not face the same sluggishness of learning that other surgery organizations suffer because we do not have the same rates of turnover; we have incredible consistency across our programs and missions. [Back to Top]

 Q: How is it possible that you can provide an open heart surgery in Iraq for less than $1,000? Is that the full cost?

A: The "less than $1k" numbers we routinely publish represent the amount in "program costs" we spend from our international donor money. The figure does not necessarily account for every single management, overhead, or fundraising expense.

Our total expenditures for FY 2010 were $188,919. We performed 82 surgeries during the same period for a per child total of $2,304 (though this data is a bit moot moving into 2010-11 as we abandon our very expensive "surgery exports" program(s) in Turkey, etc. and focus henceforth on more cost-effective in-country surgeries alone).

When all of our Remedy Mission partners are taken into consideration - including the Iraqi Government, medical companies that donate medicines and supplies, and local organizations - the real Remedy Mission cost to all donors is in the range of $5,400 - $7,000. Put another way, up to 85% of the total cost of a single surgical/training mission is now subsidized by local, Iraqi constituent institutions. [Back to Top]

 Q: So is that the same thing as saying that my donation doesn't really make a difference? That the "up to 85%" funded locally by those inside Iraq is all that is really necessary to make this work?

A: There is not a single site across Iraq for which our Remedy Missions are fully funded. If we fail to provide our 15-19% of the overall budget, Remedy Missions fail, surgeons and nurses do not get trained regularly, on-site audits from our international team do not happen, up to 20 children are delayed from receiving surgery, and a few may even die or become inoperable. Your role in funding the remaining 15-19% is as critical in the short term as any other entity. A single Remedy Mission is binary - it either happens or it doesn't. Your money makes it happen. But our goal is to continue to graduate all our programs so they are 100% funded locally in the next 5-10 years. [Back to Top]

 Q: Any other costs?

A: Our numbers per Remedy Mission do not account for "indirect costs," such as the cost (or value) of our volunteer medical staff from around the world, costs to local healthcare systems, the cost of a family to travel to the surgery site, the opportunity costs of lost income for families as they wait for surgery, etc. The reason we think it's important to note this here is because lifesaving is actually quite difficult. Building a pediatric cardiac surgery system for the entire country of Iraq is laborious and full of complexities. [Back to Top]

 Q: What is the bottleneck to more surgeries: money or skilled labor?

A: People often assume that the biggest need is more Iraqi heart surgeons. We could use a few more, but the real bottleneck is skilled nurses, technicians, and non-surgical physicians. A surgeon is only as good as his support staff. One of our biggest challenges is training pediatric cardiac intensive care nurses. To date, we haven't found a better model than our Remedy Missions through which we bring quarterly hands-on training to local nurses (and surgeons) in Iraq. Rather than exporting the nurses to Europe or the USA for training (whose medical systems barely resemble the Iraqi system), we train them with what they have on hand in their local environment. [Back to Top]

 Q: I'm skeptical of non-profits and charities because they always seem to be asking for more money. How can I be sure that Preemptive Love Coalition has "room for more funding" and that I'm not paying into a huge savings account, "Rainy Day Fund", or something similar?

A: For the record, we are skeptical of non-profits as well! In 2012 PLC needs $350,000 on hand at any given time to cover our cash flow needs for up to three Remedy Missions per quarter. We are still 30% under-funded against that goal. In addition to cash flow needs, we still require 15-19% funding on most of our missions after local sources contribute their portion; we have un-funded pilot programs in new cities where local doctors have been requesting our help (but where weve yet to woo local philanthropists or health directors); and we have research and social service initiatives through our Followthrough program that require funding at present because we have not yet sought local funding for those initiatives (seeing as how they relate mostly to our Monitoring & Impact Evaluation objectives). Please see our "Funding Gap" page to look deeper into our anticipated program costs, the sources of funding we are counting on, and the funding gap between the two for the next few years. [Back to Top]

 Q: Do you have enough volunteer surgeons available for unfunded Remedy Missions? (i.e., are there trips that you could fund if you had more money, or is there a labor bottleneck?)

A: Great question! We use a hybrid volunteer/staff model. Roughly 25-30% of any one of our Remedy Mission teams is employed by the International Children's Heart Foundation (typically the surgeon, scrub nurse, anesthesiologist, ICU doctor, and often a part-time ICU nurse). The remainder of the team typically comprises volunteer physicians, technicians, and nurses from across the world. Because the hardest-to-come-by positions are contract labor for us and NOT volunteers, we have never failed to run a mission for lack of personnel. We have only cancelled or turned down a request for a future mission due to lack of funding. [Back to Top]

 Q: Many heart surgeries require follow-up treatment (including additional surgeries). Do you have a way of providing these to patients?

A: Yes, we do. Our model dictates quarterly visits to each program site (a hospital inside a regional hub). Our reliance on local cardiologists ensures that the local team prioritizes and almost entirely sets the agenda for patient selection (within a development curricula) - after all, Iraqi doctors are the ones who are most intimately connected to the patients and their daily progress! When a local cardiologist sees a child who has either (1) deteriorated and requires another intervention or (2) advanced as expected to the next step of a complex, staged intervention, the child is prioritized for follow-up treatment. [Back to Top]

 Q: How do you assess whether surgeries are completed competently and appropriately?

A: Because we are a broker and play a combination administrative and financier role in the coalition of partners working in Iraq to develop pediatric cardiac care, we are able to stand in-between the local surgical team and the international surgical team (whom we contract as a third-party to train and perform surgeries in Iraq). If the local team or health directorate suspects a lack of competence in the international team, a cavalier attitude, or a single poor judgement call, our role is to be the go-between - to be the advocate for the local healthcare providers vis-a-vis the international surgical team.

Similarly, if the international surgical team feels pushed by the local surgical team to perform procedures with which they are uncomfortable or for which they think the local system is ill-prepared, they are able to refuse children for surgery and/or use us (PLC) as a go-between.

The checks-and-balance between the two teams helps us ensure surgeries are performed in a competent, appropriate manner. [Back to Top]

 Q: What is the rate of complications during and following surgery?

A: We report our in-hospital and 60-day mortality after each Remedy Mission. You can finds those numbers here. We also produce reports after each Remedy Mission detailing the trip, including data on intraoperative complications, post-operative complications, and mortality. You can find those reports here. We are also deliberately raising the funds necessary to help us bring our various heart hospitals into compliance with the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing Countries. If this kind of quality improvement and reporting initiative interests you, we are currently looking for financial partners for our Followthrough program. [Back to Top]

 Q: How do you assess whether surgeons are performing additional surgeries that they would have not had the funding or motivation to perform otherwise?

A: Pediatric heart surgery in Iraq is almost nonexistent without our work. There are two active programs for relatively simple surgeries (one in Erbil and one in Baghdad). Local surgeons claim that combined they perform no more than a few hundred pediatric surgeries a year. In every location where we work, pediatric heart surgery is effectively nonexistent. Therefore, every surgery performed at our program sites (both when we are present and when we are not) are "additional surgeries" that they would not have had the SKILL to perform without the FUNDING we employed to train them in their local environment. [Back to Top]

 Q: How do you assess whether surgeons are charging their patients for the surgeries you fund?

A: Because we work in public (government) hospitals - and because healthcare in Iraq is provided almost entirely free of charge - it is widely known that any cardiologist, surgeon, or administrator seeking compensation for services is acting outside of Iraqi law. [Back to Top]

 Q: Do you follow up with the surgeons you've trained to assess whether they are correctly applying their training?

A: We see them quarterly in their local environment and perform real-time audits of their skills, recollection of past training, application of new techniques, etc. Additionally, our international surgeon remains on call at any time via phone, Skype, or email for consultation. [Back to Top]

 Q: What information is available on the activities - and competence - of the surgeons you've trained?

A: Because our Remedy Mission training program only began in late 2010 - and pediatric heart surgery at our sites across Iraq is the same age - there is still relatively little independent practice to report, and therefore little data on the activities and competence of our surgeons and their teams. But as they begin performing more surgeries independently, we are trying to align each site/surgical team with the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing Countries (a data collection and tracking initiative of Children's Hospital Boston and Harvard University). [Back to Top]

 Q: Where do surgeons work after completing training? Do they serve poor patients?

A: As of Q2 2011 there was only one private hospital in Iraq (to our knowledge) providing pediatric heart surgery (and those surgeries were on the lower end of the complexity scale). Our work does not necessarily mean to exclude private hospitals as they continue to come online and become viable options, but at present the government system has a better equipped foundation for training local surgical teams. As we look to fully graduate our local surgical teams in the next 5-10 years, we imagine that most of them will stay in the public sector for all of the stability, pensions, and benefits of loyalty provided to those who stick with it. But, undoubtedly, some will seek positions at private hospitals (assuming private hospitals are willing to invest in the requisite capital purchases necessary to establish a credible program). In the public sector, rich and poor are served alike. In the private sector, poorer patients would be at an obvious disadvantage. [Back to Top]

 Q: How much do you spend each year on "program" expenses and how much on "overhead?"

A: As a rule, we do not adhere to the model that claims that "overhead" is somehow bad and "program" is somehow good. There are very bad program expenses. There are overhead expenses that are excellent investments. We agree with Paul Brest, President of the Hewlett Foundation, when he said, "Achieving a low overhead ratio drives many charities to behaviors that make them less effective and means more, not less, wasted dollars." Therefore, we spend as much on overhead as we need to accomplish our mission. The mission itself is our North Star - not arbitrary (even harmful) standards about overhead-vs-program expenditures. For the record, however, you can find a current pie chart of our expenditures here (and if you're into that sort of thing, you'll probably be impressed!). [Back to Top]

Jeremy Courtney Founder, Executive Director Twitter: @Jeremy_Courtney

“I'd love to hear any critique or questions you might have!”

DROP A NOTE OR DONATION BY MAIL: Preemptive Love Coalition 1300 Darbyton Dr. Hewitt, TX 76643 GIVE BY PHONE: To make a gift over the phone, using your credit card (Visa, MasterCard, American Express, or Discover), please call +1 (806) 853-9131 during normal business hours. IRAQ OFFICE: +964 770-355-6298 (local)

Serhang is Inoperable

February 23, 2009 by Jessica · 1 Comment 

We found out late Friday night that Serhang Yassen would not be receiving surgery while in Turkey.  Unfortunately, he was initially misdiagnosed and the doctors now know that he is missing his pulmonary artery.  This is the artery that helps regulate the blood pressure from the heart to the rest of the body.  As a result of this his blood pressure is very high.  The doctor said that Serhang would be unable to survive the surgery.  He and his mother returned to Iraq on Saturday.  We went to their village to see them today and Serhang was all smiles and hand shakes.  He loved his time in Turkey and thinks it is the most beautiful city.  His mother and father are very sad about the diagnosis and kept asking us today if there was any hope.  We cried with them and told them that we have not lost hope for Serhang; that we believe that the God who created him has the power to heal him and we would continue to pray for him.  We sat next to Serhang on the floor and put our arms around him and prayed for him.  He is the sweetest, most gentle child and I think he wants to marry our physical therapist some day.  His mom told us that while in Turkey when the doctors were having to do tests she would tell Serhang that if he would behave when he went back to Iraq he could grow up and marry one of us.  Remember Serhang and his family today, because we cannot forget him.

Jessica Courtney lives and loves in Iraq as a co-founder and Family Services Director of the Preemptive Love Coalition. She is also a mother of two children and is married to PLC's Executive Director, Jeremy Courtney. When not absorbed in caring for Iraqi children and sharing life with Iraqi families, she enjoys sewing and scrapbooking.

All Smiles as Children leave ICU

February 19, 2009 by Jessica · Leave a Comment 

This is a visual post to let you all see how much the children are enjoying their newly repaired hearts. It is amazing to see pink cheeks and big smiles where we once saw withdrawn scared little faces. So here they are. Enjoy these images and thank you on their behalf for all you have done to help them get to surgery.

Jessica Courtney lives and loves in Iraq as a co-founder and Family Services Director of the Preemptive Love Coalition. She is also a mother of two children and is married to PLC's Executive Director, Jeremy Courtney. When not absorbed in caring for Iraqi children and sharing life with Iraqi families, she enjoys sewing and scrapbooking.

Ahmad Out of Surgery! No More Blue Skin! All is Pink & Healthy!

February 17, 2009 by Jeremy · 1,042 Comments 

Ahmed is out of surgery. His oxygen levels are already up by 25%. His future is hopefully less blue and a more healthy pink. His dad is crying tears of joy.

Dr. Çiçek at the Anadolu Sağlik Merkezi was clear that this is not a long-term, fully corrective solution; but this first surgery should allow him to finally live long enough to receive the staged surgeries he’ll need over the coming years to actually live a fully functional adult life.

We’ll update with more information as soon as we know it.

Follow Ahmad’s daily updates on Twitter or via his RSS feed.

Jeremy Courtney lives and loves in Iraq as a co-founder and Executive Director of the Preemptive Love Coalition. He's also the father of two spectacular children, and married to the lovely Jessica Courtney. When not absorbed in PLC work he can be found writing songs and singing about hope and future. Follow Jeremy on Twitter: @Jeremy_Courtney.

Taban Comes Through Her Surgery!

February 16, 2009 by Ruth · 2 Comments 

Yesterday at 0900 Taban underwent a 3 hour surgery to close the hole in her heart! Our staff in Turkey emailed last night to say that the surgery went well. We called her family to let them know and they sounded so excited! We’ll update you when we hear more!

You can follow Taban’s progress on Twitter or via RSS here.

Ruth Simpson was a Family Advocate for the Preemptive Love Coalition in Iraq (2008-2010) and a certified physio-therapist. Ruth hails from Ireland, though she's slowly losing her amazing accent amongst all the Americans. When not sharing her life with PLC's kids in Iraq, she served other constituent groups with her rehabilitative skills and compassion.

The Preemptive Love Coalition covered by NEED Magazine

February 16, 2009 by Jeremy · 60 Comments 

Thanks to Michael Duffield and NEED Magazine for covering Kadeeja’s stories and lending your voice in support of the effort to help Ahmad and the others from the Great Eight whose surgeries we are funding in Turkey right now.

Click here to read the article online.

Jeremy Courtney lives and loves in Iraq as a co-founder and Executive Director of the Preemptive Love Coalition. He's also the father of two spectacular children, and married to the lovely Jessica Courtney. When not absorbed in PLC work he can be found writing songs and singing about hope and future. Follow Jeremy on Twitter: @Jeremy_Courtney.

Surgery for Serhang

February 16, 2009 by Jessica · 932 Comments 

Serhang will be leaving for surgery in less than 48 hours!  His family has been waiting for this opportunity for him to receive the surgery he needs to be able to sleep comfortably at night and walk to school every day without breathing trouble for 11 years.  They have known since birth that Serhang had a serious heart condition known as TOF (Tetralogy of Fallot), which is a very complex heart condition involving a hole in the heart and switched arteries.  He was identified as an urgent case and his family was very relieved to receive the news that he will go to surgery so soon.  Even with the severity of his heart condition, Serhang continues to get up and walk to school every day.  However, he has been unable to make it past the first grade because the lack of oxygen his body and brain receive make it really difficult for him to learn.  We rejoice with Serhang and his family in this opportunity for him to receive the surgery he needs to grow up and play and learn with the other children his age.

Jessica Courtney lives and loves in Iraq as a co-founder and Family Services Director of the Preemptive Love Coalition. She is also a mother of two children and is married to PLC's Executive Director, Jeremy Courtney. When not absorbed in caring for Iraqi children and sharing life with Iraqi families, she enjoys sewing and scrapbooking.

From Airport to Hospital (Istanbul, Turkey)

February 15, 2009 by Jessica · Leave a Comment 

Right now we’re driving to the hospital from the airport in the ASM shuttle. After traveling all night these kids are definitely tired, but overall in good spirits. Taban showed up in pig tails at the Suli airport as we began our travels. Ranu came with her baby doll that she loves carrying around and picking up as though she is a real baby. Zana came entertained with an electronic handheld game. Ahmed is as sweet and shy as ever, slowly taking everything in around him. They all love the shiny star stickers. Zana is even wearing one on his first forehead.

Waiting in the lobby just before boarding Ahmed was fascinated by the airplane just outside of the windows. He took in every part with great awe. Once we landed in Istanbul, I wondered what Taban, coming from a small village, was thinking as we walked through the Istanbul airport. With great enthusiasm she looked from one conveyer belt to the next and then insisted on pushing a luggage cart, even in her tired state. I think it was as fun for her as any game could have been.

Jessica Courtney lives and loves in Iraq as a co-founder and Family Services Director of the Preemptive Love Coalition. She is also a mother of two children and is married to PLC's Executive Director, Jeremy Courtney. When not absorbed in caring for Iraqi children and sharing life with Iraqi families, she enjoys sewing and scrapbooking.

Five of the Great Eight Land in Turkey

February 15, 2009 by Jeremy · 49 Comments 

We’re happy to announce that five of the eight surgery candidates have successfully landed in Turkey, have been received by ASM – our medical partner in Turkey – and are beginning the necessary steps to undergo surgery in the coming days.

If all goes well, some of them will be back with new hearts in as few as two or three weeks.

The second group of the Great Eight is set to travel on Tuesday night!

Thanks for your support and generosity!

Preemptive Love Coalition

Jeremy Courtney lives and loves in Iraq as a co-founder and Executive Director of the Preemptive Love Coalition. He's also the father of two spectacular children, and married to the lovely Jessica Courtney. When not absorbed in PLC work he can be found writing songs and singing about hope and future. Follow Jeremy on Twitter: @Jeremy_Courtney.

Taban is in Turkey!

February 14, 2009 by Ruth · 1,010 Comments 

Yesterday afternoon we had one final meeting with the families before sending them off to Turkey very early this morning. Scott and Abby are travelling with them and we just heard from Scott that they are on the bus on the way to hospital. More to come later!

Ruth Simpson was a Family Advocate for the Preemptive Love Coalition in Iraq (2008-2010) and a certified physio-therapist. Ruth hails from Ireland, though she's slowly losing her amazing accent amongst all the Americans. When not sharing her life with PLC's kids in Iraq, she served other constituent groups with her rehabilitative skills and compassion.

The Great Eight (Taban)

February 12, 2009 by Jessica · 4 Comments 

After only 2 weeks in Iraq, working with families who’s children need heart surgeries to grow into adulthood, it was an exciting day to come face to face with two of these families and their children. Both families, whose children are 11 and 13 years old have known since birth that their children have serious heart conditions.

It was wonderful to be the bearer of such great news and tell Taban’s family, who has been waiting for 13 years to find a way to help cure their daughter, that she will be able to leave for surgery on Sunday. In just a few short days she will be on her way to Turkey where she will receive the heart surgery she desperately needs. I have been very touched by the kindness and devotion of these families to do whatever it takes to help their children get the surgeries they need. They are willing to entrust their children, their futures, and even invest their hope in us, The Preemptive Love Coalition.

As we shared several glasses of tea with them, they took the time to welcome me to their country and their village and thank me for leaving my home in America to come and help their children. Although these two children urgently need surgery, the Doctor reviewing their cases is very hopeful that their surgeries will be successful.

Not all of the children we have seen this week have as much hope for a full recovery, or even that they are eligible to receive surgery. And even in the midst of being the potential bearer of wonderful or terrible news for these families, I would not choose to be anywhere else in the world than here in Iraq sharing in the joy,

sorrow, hope, pain, and healing of these children and their families.

Jessica Courtney lives and loves in Iraq as a co-founder and Family Services Director of the Preemptive Love Coalition. She is also a mother of two children and is married to PLC's Executive Director, Jeremy Courtney. When not absorbed in caring for Iraqi children and sharing life with Iraqi families, she enjoys sewing and scrapbooking.

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Preemptive Love Coalition provides lifesaving heart surgeries for Iraqi kids in pursuit of peace between communities at odds. We offer the 30,000 Iraqi children suffering from life-threatening heart defects a chance at the surgery they need to save their lives. With our world-class international surgical partners we create long-term solutions by training local Iraqi doctors and nurses so they can sustainably save lives without our help.

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