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)

Encouraging Words From a US Marine

May 15, 2011 by Jeremy · 2 Comments 

Just in case the image didn’t load or if you’re having trouble reading the letter:

“Dear PLC, My name is —- and I’m sending this check to you in order to support —- in her Summer Internship to Iraq this year. As an Arabic Linguist in the Marine Corps with a background in studying Arab and Iraqi culture, as well as Terrorism and Insurgencies, I want you to know that I see what you do to help the Iraqi people as being one of the greatest ways to help stabilize Iraq and disarm the violence in the region. The medical missions trips and fundraising that you do is an amazing way to reach the Iraqi people that really protects the most valuable part of their lives – their children. Your mission of saving lives is the greatest way to spread God’s universal message of love. That same calling to love is why I am sending you this check now. It’s not a payment for any kind of material goods or services, it is simply my support for both a wonderful student and a great organization, the two of which I know will change lives and have a great impact on the World for God. Please stay safe, and persist always in love.”

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: @JCourt.

We were featured in the new book, “Act Here. Love Now.”

May 13, 2011 by Cody · Leave a Comment 

PLC is honored to be featured in the new book Act Here. Love Now.

We love that we get to share pages with eleven of the most passionate and talented photographers we’ve come across!

Read their story and see just how contagious their passion is:

Act Here. Love Now. is a book that follows the journey of 11 student photographers who had a vision to change the world. They traveled through 36 countries documenting the lives of those they met. As they took photos and heard stories, they were overwhelmed with the needs that confronted them along the way. But as the days wore on, the girls realized they could make a difference, every day, with simple acts of genuine love. This book is a culmination of their stories, photos, and practical ways to impact your own community, city, and world.

We believe that whether we are in our hometowns or across the continents, if we impact our neighborhoods, we will transform our cities. And if we transform our cities, we will change the world.

Let’s go.

Through their photography and gripping stories, they’re accomplishing everything they set out to do.

We can’t wait until we get some of their books out in Iraq!

Get yours by clicking HERE!

Cody Fisher is the co-founder and Development Director of the Preemptive Love Coalition. He moved to Iraq in 2007 where he met his wife and since then they've been waging peace and mending hearts across Iraq. His passions are photography, peacemaking, and food that doesn't come out of a can. You can follow him on Twitter: @candmfisher.

“Without Soul” by Jamal Penjweny

May 11, 2011 by Cody · 2 Comments 

“As a child I would often draw human figures, landscapes, animals and tanks. Anything I would find around myself. I would do it as any other kid going to the public school. But at home I was told that it is not a right thing to make images of living creatures as it is a work of God, not of the human being. It is so because the one who gives the shape of the being is obliged to give it a soul in the next life.”

“However, by drawing a line against the neck of the represented one can announce to God that he invalidates the image and is not claiming a position of the creator.”

“Today, as someone dealing professionally with representation I return to this moment in my childhood and undertake the gesture of invalidation, by crossing the neck of any represented figure with the red line. In a way it refers to the common telling that the photographer is the one who steals the soul of the photographed.”

-Jamal Penjweny

Photos courtesy of Jamal Penjweny. Go HERE to browse more of his work throughout Iraq.

Cody Fisher is the co-founder and Development Director of the Preemptive Love Coalition. He moved to Iraq in 2007 where he met his wife and since then they've been waging peace and mending hearts across Iraq. His passions are photography, peacemaking, and food that doesn't come out of a can. You can follow him on Twitter: @candmfisher.

Featured Partner: Behar Godani

May 9, 2011 by matt · 1 Comment 

Behar Godani is the kind of person non-profits dream of having in their corner. In fact, if you search “ultimate supporter” in Wikipedia… well, you mostly get a bunch of gibberish, but you should see her photo.

She started spearheading support for PLC way back in the day; fund-raisers, spreadin’ the word, Facebook “likes”, bake sales—she’s done it all! And that’s great for an overseas staff like ours because we don’t spend much time Stateside. She’s a lifeline across the Atlantic, and today (which also happens to be her birthday!) she agreed to an interview:

PLC: Let’s start by hearing a little about you. Tell us about yourself.
Behar: My name is Behar, and I’m now a 25 year-old student program analyst for the US Department of State. I recently graduated with my MA in Political Science and my Graduate Certificate in Bio-defense for Critical Analysis and Strategic Responses to Terrorism. I’m interested in anything and everything relating to politics in the Middle East, although, being Kurdish, I’ve always had a bias for the politics surrounding Iraqi Kurdistan.

Over the past year I’ve been a co-partner in two projects that resulted in the production of a documentary and short film on the Kurdish Diaspora in the US, and I did some work with the US Institute of Peace where I was featured in a documentary about issues in diaspora communities.

Non profit work through various organizations has also always been a profound interest of mine. The use of media to promote issues within my own diaspora community and my Kurdish community back home has been a way for me to feel like I’m contributing in some positive way—however small—to a homeland that I’ve always felt connected to but have never quite had complete access to.

My ultimate aspiration, on a more general level, would be to finally see peace in Iraq as a whole, but, more specifically, I yearn for the day when my particular country—Kurdistan—is finally independent and when its children have the educational and healthcare initiatives in place that ensures a long term, brighter future for generations to come.

PLC: So how did you hear about the Preemptive Love Coalition?
Behar: Maureen Mcluckie from “Kurdistan: Save the Children” first referred me to Jeremy and Cody via email after I expressed my desire to become directly involved with an NPO helping Kurds and Arabs in Iraq from the states.

When I first saw the initial BuyShoesSaveLives website, I remember getting goosebumps as I couldn’t believe the amount of dedication and love PLC put into helping Iraqi children and how easy it was for anyone to simply donate. They even had ideas about how we as students could get involved at our universities, and that’s when I think I knew I’d found the right organization.

Seeing teenagers wear klash with jeans was perhaps another indicator. Who knew Kurdish shoes could look so cool with jeans?!

PLC: You’ve obviously got a big heart for your homeland and these children. Where does your motivation for them come from?
Behar: I think my greatest motivation has been a sincere desire to move beyond the politics and crippling bureaucracy that’s done such a huge disservice to all Iraqis and to simply start at the grassroots level by helping people.

As a child of two Kurdish parents who first came to the US as refugees about thirty years ago, I’ve seen the power of grassroots movements first hand in terms of keeping culture and language alive, but also by bringing people together in the name of a greater cause that we can all believe in.

Helping sick children, many of whom continue to suffer from the diseases contracted by their parents after exposure to Saddam Hussein’s chemical agents, is a cause that is—or at least should be—an easy way to unite people of all backgrounds, be they Kurdish, Iraqi, Turcomen, Assyrian, or your average American with an incredibly big heart. It’s something we can all agree on as human beings, and I couldn’t find an organization that communicated that better than PLC.

PLC: Thanks! Is there anything you’d like to tell the rest of the Coalition? Any rally cries, encouragements, or challenges?
Behar: I’d like to encourage continued commitment despite all the opposition, obstacles and incredibly vocal naysayers that you may encounter along your way. Where there are pure hearts, strong wills, a love of God and a refusal to accept ‘no’ for an answer, there will always be a way, God-willing.

—

Our thanks to Behar and the entire Kurdish Student Organization at George Mason University for being such awesome partners for kids in Iraq! We’re wishing you a happy birthday today from Iraqi Kurdistan!

As PLC's Press Secretary, Matt Willingham writes, reads, edits, tweets, updates, and works with a camera so as to connect hearts and minds to Iraqi children in need. On the side, he likes reading stories, devouring the great food his wife cooks up and exploring DSLR work. He's also mildly obsessed with Twitter: @mehtin.

What Better Way To Celebrate Life Than By Saving A Life?

May 7, 2011 by Cody · Leave a Comment 

“In celebration of the upcoming birth of our second son we are so very excited to join the Preemptive Love Coalition in raising enough money for one child’s life-saving heart surgery.”

-Kristian & Katy Rose

Learn more about their efforts HERE.

Cody Fisher is the co-founder and Development Director of the Preemptive Love Coalition. He moved to Iraq in 2007 where he met his wife and since then they've been waging peace and mending hearts across Iraq. His passions are photography, peacemaking, and food that doesn't come out of a can. You can follow him on Twitter: @candmfisher.

To Know Honya Is To Love Honya

May 4, 2011 by matt · Leave a Comment 

Honya was the first child I met when I visited PLC back in ’09, so I was excited when Honya’s father invited us to picnic with their family. Not surprisingly, she’s still as loveable as ever, and it was great to see her so healthy and happy over a year after surgery!

As PLC's Press Secretary, Matt Willingham writes, reads, edits, tweets, updates, and works with a camera so as to connect hearts and minds to Iraqi children in need. On the side, he likes reading stories, devouring the great food his wife cooks up and exploring DSLR work. He's also mildly obsessed with Twitter: @mehtin.

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OUR BLOGGERS

	Matt Willingham is the PLC press secretary and writes primarily on politics, history, general updates and visual peacemaking through photography and film.
	Cody Fisher is a PLC cofounder and writes primarily on program development and peacemaking by giving us a lens into the lives of the real people we love.
	Jeremy Courtney is a PLC cofounder and writes primarily to emphasize our vision and values, including organizational and financial transparency.

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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