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)

In A Word: “Mend”

November 30, 2011 by Lydia · Leave a Comment 

To see more by Polish artist/cartoonist Pawel Kuczynski, go here.

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

In A Word: “Thanksgiving”

November 23, 2011 by Lydia · Leave a Comment 

Miles outside of Sulaymaniyah, a man gives thanks and prays as the sun sets behind him.

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

Photographer Farewell

November 22, 2011 by matt · Leave a Comment 

Friends, today is a sad day. After 7 months of working together, we’re saying goodbye to our photographer, Lydia O’Neil. She’s headed home to finish her last semester at the Corcoran College of Art + Design.

If you’ve spent time exploring any of our online real estate, you’ve probably admired her photos. We’ve received countless messages from people saying how much they enjoyed her Daily Squares on Facebook, her photos of children, and her work on our Flickr stream.

So, while we’re sad to see her go, we’re excited to see what her future holds. If you’ve admired her work, head over to her personal website and tell her so. I’m sure she’d appreciate the encouragement! You can also follow her on twitter here.

Goodbye, friend! We miss you already and hope, insh’allah, to work with you again soon!

Much love,

The PLC Staff

As PLC's Press Secretary, Matt Willingham is bent on leveraging words and media to connect hearts and minds to Iraqi children in need. On the side, he likes reading old books, devouring the great food his wife cooks up and dabbling in DSLR video work. He's also mildly obsessed with Twitter: @mehtin.

Remedy VII Sends Us Along With 24 Healthy Children Home!

November 20, 2011 by Cody · Leave a Comment 

Writing the closing post for a Remedy Mission feels a little bit like writing an acceptance speech for the Oscars (Or at least it’s how I imagine it would feel!).

It’s simply overwhelming thinking back over the past two weeks, remembering all the smiles and the stories of the 24 children we witnessed being saved, the 20 hour work days that the surgical team gave, the thousands of hours of teaching that were given and received, and the joyous families who left the hospital with their healthy children in tow.

While there are so many things to focus on and so many thank yous that could be given – you are the one person I don’t want to miss thanking.

Because, without you, we wouldn’t have been able to bring our 7th Remedy Mission to Iraq. Without you, we would still know some of the best doctors and nurses in the world, but we would have no way of actually bringing them to Iraq to save lives. Without you, we would continue to meet families all over Iraq with sick children, but we would have no remedy to offer them. Without you, we wouldn’t have just witnessed our most successful, most lifesaving mission yet.

And, without you, we wouldn’t be just weeks away from our next Remedy Mission.

So in case you haven’t noticed the pattern here. We don’t like doing this without YOU!

Dramatic things happen when you give. This Remedy Mission was only more proof of that. Thank you for generosity. It’s saving lives all over Iraq and for that I can’t thank you enough.

Our 8th Remedy Mission is just around the corner, and we want you to be a part of it.

To begin assembling the next medical team and to start gathering a new group of children who need to be saved from all over Iraq, donate here to make it happen in time for our next mission!

Our Partners:

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.

After A Successful Surgery, Fatima Is Now Recovering In ICU!

November 18, 2011 by matt · Leave a Comment 

If you’ve been following Fatima’s story, you’ll be happy to hear that her surgery was a HUGE success! Her mother was right: this was a gift from God. She may not seem energetic now, but in a few days she’s expected to be as joyful and fun as ever.

As of today, the grand total of heart operations for Remedy Mission VII is 24! That’s the largest number of lifesaving operations ever provided during a single mission, and it also puts us over 200 total!

These are big milestones, and they’re proof that you and I–along with the rest of the Coalition–are capable of truly blessing hundreds of families in Iraq. Right now, 24 families in southern Iraq are on their way home to celebrate new life. Thank you for giving them that reason to celebrate!

Our Partners:

As PLC's Press Secretary, Matt Willingham is bent on leveraging words and media to connect hearts and minds to Iraqi children in need. On the side, he likes reading old books, devouring the great food his wife cooks up and dabbling in DSLR video work. He's also mildly obsessed with Twitter: @mehtin.

The Mobile Photo Booth: Why Can’t All Hospitals Be This Fun?

November 18, 2011 by Lydia · Leave a Comment 

As the PLC photographer, my job breaks down like this: 98% smiling kids, 2% me clicking the shutter, right?

But since I spend a lot of time with the kids and staff, I’m always looking for ways to make their days at the hospital a little less hospital-y.

After a few hours with some cardboard and a sharpie, the “Mobile Photo Booth” was born!

I spent the last couple days walking around the hospital handing kids and nurses their secret identities!

Check out the Daily Square on our Facebook page to see more!

Our Partners:

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

Mohammed’s New Heart…and Handlebar Moustache

November 17, 2011 by Cody · Leave a Comment 

If you’re a child in a hospital waiting for a lifesaving heart surgery, your days are going to be crazy. There’s no way around it.

You’ll be whisked away from one appointment to the next. The cardiologists want to look at your heart, the nurses want to understand your blood, the doctors want to get their hands on your medical reports, and your parents are being walked through the actual procedure that will be performed on your heart. For sick children, life in the hospital is chaotic at best.

But Mohammed isn’t sick anymore. He experienced the rushing of the days leading up to his surgery, but now that he’s no longer sick his days are pretty boring!

The doctors don’t need to see him anymore. The cardiologists have seen all they need to see to know Mohammed’s heart is in great shape. The nurses have no reason to run more tests or prescribe medicine. His medical reports are now stamped “CURED” and are a thing of the past.

There’s no reason for healthy children to be in the hospital and there are less and less reasons for Mohammed to stick around any longer!

But we’re taking advantage of our down days with Mohammed – playing soccer, going on walks and trying out moustaches.

What do you think of this one?

We knew you’d like it.

Our Partners:

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.

Just Hours Before Her Surgery, Fatima’s Mother Says, “This is a gift from God!”

November 16, 2011 by Lydia · Leave a Comment 

I had the hardest time deciding which picture to use to introduce you to Fatima. This last week she’s been such a star for the camera—aka, exactly the kind of kid I love! In fact, if you didn’t see her in Remedy: The Flipbook you should stop reading and go do that here. But Fatima’s charm goes beyond her camera antics. There’s no way to describe it except this: she is so full of JOY. She’s here with her mother, and the two of them just fuel each others laughter all day long. It’s been so much fun having the two of them around.

I got some of the back-story on Fatima and her mother–want to hear it? Fatima is the youngest of four. Her father is out of work, and her mother works from home as a seamstress to make ends meet. When Fatima was born, the doctors told her mother that the hole in their daughter’s heart was the fault of the war. A remnant of the violence of the foreign countries who had attacked their homeland for so long.

Like so many other families, their only option would be a costly trip abroad. But at a seamstress’s salary, she knew she could never pay for this trip. “We could only give it over to God,” she says.

Several months ago they saw an ad on TV; foreign doctors were coming to her! Forget leaving the country—she wouldn’t even need to leave her city! She couldn’t believe it, but “This,” she says, “this is a gift from God.”

Fatima is just hours away from her life-changing operation. Why don’t you use these next few hours to share her story with a friend?

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

Introducing Remedy: The Flipbook!

November 14, 2011 by Lydia · Leave a Comment 

Many of you have asked us what a typical day is like around the hospital during a Remedy Mission. Watch the video to see snapshots of surgeries, paperwork, and best of all: playing with the kids!

Our Partners:

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

Meet Sara, Our Youngest ICU Nurse

November 13, 2011 by Lydia · Leave a Comment 

There aren’t a lot of 17 year-olds working in intensive care units.
But for Sara, it was all she’d ever dreamed of. Now, two years later, she’s still the youngest person on “the unit” and loving her job more than ever.

She hurries around the ICU, checking on her patients and helping make them as comfortable as she can. Our international staff brag about how enthusiastic she is each day and how quickly she adopts new procedures. In a busy environment that can quickly overwhelm, Sara thrives:

“I’ve only ever worked in the ICU, and I don’t want to work anywhere else!”

She couldn’t stop smiling as she told me about her love for nursing. Especially caring for children and babies. “When a baby cries you can hold it and comfort it until it stops…I love that.”


But she’s also just so excited about the local heart center. She’s excited about being part of something that’s growing in her hometown. She’s one of the first to be part of a new kind of nursing for Iraq, and we’re honored to be working alongside her!

Our Partners:

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

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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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