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)

Mohammed’s Heart Is Fixed!

November 13, 2011 by Cody · Leave a Comment 

Just a few hours ago little Mohammed, Iraq’s first pediatric heart patient from Pakistan, passed through surgery with flying colors!

From the medical stand-point, there is absolutely nothing wrong with his heart anymore. It’s completely fixed!

Now he’s becoming a minor celebrity here in the hospital. Everybody wants to see the boy who came all the way from Pakistan to have his heart fixed. They better snap their photos fast, because Mohammed’s itching to get back to Pakistan to drive his jeep he’s been telling us all about!

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.

Little Zain Comes Back To See the Remedy That Saved His Life

November 12, 2011 by Cody · Leave a Comment 

Recognize this baby?

It’s okay, neither did we!

This is little Zain, and you helped give him a lifesaving heart surgery when he was only 2 weeks old. Now he’s 5 months old and already a rockstar because, on our last Remedy Mission, he became the very first child to ever receive an ‘arterial switch’ surgery inside Iraq (It’s a big deal, trust me!). Since then, he’s more than doubled his weight and now he’s growing, scooting, stacking and doing all the things 5-month-old rockstars were created to do.

Zain’s father carried him inside the hospital today, ALL smiles, and wanted us to see for ourselves what the surgery had done.

So, now we’re the ones, ALL smiles, wanting you to see what YOU have done for Zain and his father!

Zain has no idea how big of a deal his surgery was — he’s probably just thinking about the next meal and wondering who’s going to hold him next, and we love it!

All we care about is the fact that he never has to think about his heart defect again.

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.

Why Generosity Is Another Sign of Health in Iraq

November 10, 2011 by Cody · Leave a Comment 

It was a few weeks back that I received an e-mail from a captain in the Pakistani military. His son, Mohammed, had a heart defect and he was looking for a way to save him. He was willing to travel anywhere and cross any border if it meant fixing Mohammed’s heart.

Is there anything you wouldn’t do for your son?

Other countries had offered to accept Mohammed for surgery, but the cost was high. Then he heard about the Remedy Missions taking place in Iraq and the opportunity for his son to be saved by the hands of Iraqi and American surgeons. Up until now, thousands or Iraqi children were sent outside Iraq to be saved in other countries, but a child hasn’t ever been brought into Iraq for this kind of surgery.

Mohammed would be the first.

While other countries saw Mohammed’s surgery as another financial transaction, the Ministry of Health in Iraq removed every barrier that stood in their way and brought them to this Remedy Mission.

Yesterday, I stood in the hallway talking with Mohammed’s dad and he brought up the name of our coalition, Preemptive Love. He started to share what that meant to him and his family and then he told me, “I believe that this act [preemptive love] is what we were created to do.” He went on to share how he’s been thinking about it and trying to understand how his life could reflect it even more.

We kept talking as his son was playing soccer in the hallway, and then it struck me in a whole new way just how much a single act of love can impact a life. The doctors in Iraq could have turned them away. They could easily have justified it with their own backlog of thousands of Iraqi children waiting in line for surgery. But they didn’t. They welcomed him in and received their very first international patient from outside Iraq.

Talking with the local doctors here, it’s obvious that this surgery has helped them change the narrative of healthcare in Iraq. For so long they’ve only been on the receiving end. They’ve always been the ones asking other countries to help their children. This was their chance to give back.

Now they were able to even show their own people that, one day, Iraq can be a place where others come for help.

In a few hours, Mohammed will be the first international patient to be treated inside Iraq.

Stay tuned!

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.

The Hope, Dream & Imagination Behind A Photo (And How It Affects You!)

November 10, 2011 by Cody · Leave a Comment 

When we walk into another Remedy Mission, we’re not just walking into a hospital, we’re walking into the lives of families, children and new doctors and nurses who have come from all over Iraq to receive training.

And that’s why we’re on the ground for each mission in Iraq – because we don’t want to miss out on the lives of those you’re impacting.

Today our photographer, Lydia, sat down with a mother and her son, Hussein, (pictured above) and asked her if she could take his photo.

She said, “Please take as many photos of my son as you want so that you can tell others how important it is for these teams to come here.”

Her hope behind this photo was that others would see it and see the impact that they can make by supporting these missions.

What continues to amaze me about the families we’re meeting this Remedy Mission is how every single one of them recognize that these missions don’t just happen on their own. They know that doctors and nurses from all over the world don’t just hop on a plane and show up in Iraq. Remedy Missions don’t just randomly pop up all over their country. They know there’s a community behind each mission and they know a lot goes into each one.

Many donate their time volunteering so that missions can continue to come to Iraq. Many give sacrificially so that money is never the reason children can’t receive a remedy. Many help spread the word about children like Hussein who are born with heart defects and MANY are taking action this week to save his life.

Hussein’s mother understands the impact of an image. She understands it because she understands the impact one individual can make.

You continue to remind us of that every day.

So start posting, tweeting, and telling your friends about this week’s Remedy Mission — let’s see what kind of impact we can make!

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.

Remedy Mission VII Starts Now!

November 8, 2011 by matt · 1 Comment 

As you read this, families are trickling into the hospital in southern Iraq and our staff are ready to receive them. The names in the video represent all the children who we hope to save over the next 2 weeks. Pick out a couple names, pray for their wellness and stay tuned for stories!

More to come…

Our Partners:

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.

It’s Here: The #1 Surgical Training Program In Iraq

November 2, 2011 by matt · Leave a Comment 

Have you heard about Remedy Fellowship? It represents our most comprehensive strategy for saving lives to date!

You know all those short-term surgical missions you’ve been sending to Iraq? Well we’re taking the leading specialists from those teams and planting them in Iraq for an entire year!

Back in 2007 we told you we wanted to save lives, and you believed us, joined us and made it happen! Now join us and the rest of the Coalition again in this new stage of life-saving and doctor-training!

Visit the Remedy Fellowship webpage here to learn more about how you can make this happen!

###

Our 7th Remedy Mission in Iraq begins this weekend! Surgical missions like this one made larger programs like Remedy Fellowship possible, and none of them could have happened without your care. Stay tuned as we bring you more stories directly from the hospital!

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.

« Previous Page

SIGN UP FOR OUR FREE NEWSLETTER






Get our good news stories straight into your reader or inbox for free!


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.

• Popular Tags

  Amman Arab Baghdad BSSL Buy Shoes. Save Lives. buyshoessavelives CHD children Congenital Heart Disease Development echocardiogram God heart heart disease heart surgeries Heart Surgery hope hospital Hussein ICHF ICU Internship Iraq Iraqi children Istanbul Jeremy Courtney Jordan Klash Kurd Kurdish Kurdistan nasiriyah peace Peacemaking PLC remedy Remedy Mission Rezhin saddam hussein Southern Iraq sulaymaniyah Surgery Tarza Turkey Wordless Wednesday

• Archives

  • 2012
  • 2011
  • 2010
  • 2009
  • 2008
  • 2007

• Contributors

  • Adam Brandt (4)
  • Alex Phillips (10)
  • Anton Warkenton (1)
  • Awara Hassan (6)
  • Behar Godani (1)
  • Benjamin Chasnov (1)
  • Cayla Willingham (3)
  • Claire Baker (1)
  • Cody Fisher (102)
  • Esther Perez (6)
  • Jeremy Courtney (87)
  • Jessica Courtney (20)
  • Joshua Gigliotti (23)
  • Lauren Sawyer (2)
  • Liz Jones (1)
  • Lydia Bullock (52)
  • Matt Willingham (77)
  • Preston Wright (4)
  • Ruth Simpson (16)
  • Ryan Rosenberry (2)
  • Sophia Pappas (6)
  • Ted Harrison (3)
  • Tim Mason (1)