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?"


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 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)

Looking Back—3 Ways My Internship in Iraq Changed Me for the Better

May 17, 2012 by matt · Leave a Comment 

As I write this, our 2012 interns are in the air and headed toward Iraq! So it only seemed appropriate to share a few lessons-learned by former intern Lauren Sawyer. Lauren wrote out 3 of the most beneficial things she took away from her time here in Iraq, and we’re hoping this year’s interns will also benefit personally as they help us save lives.

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It’s been two full years since I boarded the first of three planes that would take me to Iraq.

Yet I still remember what I was talking about when I first landed in the desert country. Another intern, Lydia, and I were trying to rewrite the words to “Party in the U.S.A.” to fit our situation. By the end of the summer the song became “Party with the P.U.K.,” for a political group in northern Iraq. (Sophisticated conversation? Not so much.)

I have so many memories of that summer in Iraq: the places I ate, the taxi rides, the late-night chats on the roof of our house. But more than that, I have a series of life-changing realizations. Iraq changed me: it changed my perspective, it changed my behavior. Here are a few ways:

(1) People are just people wherever you go.
While in Iraq, a fellow intern Claire and I used to hum Regina Spektor’s song “The Ghost of Corporate Future” with the lyrics: “People are just people; they shouldn’t make you nervous.” I’m convinced we got that song stuck in our heads as often as we did because of that first line: “People are just people.” We found ourselves saying those words all the time, whenever we met another Iraqi we had something in common with.

The similarities between me, a young American girl, and the Iraqis I met were most clear in the English class Claire taught. I noticed how our Iraqi students watched the same TV shows as us (Vian loved “Grey’s Anatomy”) and had similar views on marriage, even, and education.

But more than that, I met people who were fundamentally like all people I knew in the States. I met fathers who loved their children, who would do anything to keep them healthy. I met children who loved games and were happy always—even when they were on their way to surgery.

Now that I’m back in the U.S., I still have opportunities to remind myself of this truth, that people are just people. I’ve spent the past two summers working for a nonprofit that advocates for people with disabilities. I’ve learned there, too, that people are just people— whether they are blind or have Down Syndrome. People are just people.

(2) We cannot accurately critique people without having truly experienced their culture.
Last semester I was sitting in my freshman-level philosophy course—as a senior—counting how many times the blonde freshman-but-sophomore-by-credits said something rude and untrue about Muslims. In that same class I heard my professor and other students make claims about how Iraq is “Worse off now that the U.S. troops are leaving”—as if these silly Midwest American civilians knew anything about life in Iraq.

My roommate and my boyfriend both told me to just say something and I did, once, without much effect. Changing someone’s mind about a culture isn’t easy.

Living in Iraq for two months taught me that you cannot critique or judge a culture without having experienced their culture like an insider. Visiting Italy for a few weeks is not the same as living like an Italian, speaking the language, shopping where they shop, eating their food, learning about their politics, their history. My two-month stint in Iraq taught me that I didn’t know enough about Iraq to critique it.

I need to keep asking questions. As soon as I stop asking questions and think I have it figured out, I’ll inevitably hurt someone or lead others to believe a lie. So when people like that freshman-but-sophomore-by-credits girl say something I know is untrue to my experience in Iraq, I need to do more than just correct them. I need to show them how to ask questions, to hunger for understanding, and to have an imagination, which leads me to my last point…

(3) We are called to be people of imagination.
I heard about the Preemptive Love Coalition when I had lost all faith in my future. I was 19 years old, and I thought that just because my life wasn’t heading in the direction I thought it should, it was over. But after reading PLC’s mission statement and then talking to Jeremy and Cody about their vision for Iraq’s future, my faith was restored. I recognized even before I boarded those planes that those working for PLC were people of imagination, and I wanted to be a part of it.

I’m convinced that you can’t do anything big and life-changing without having imagination. I doubt PLC would have ever existed without Jeremy and friends imagining a life without heart defects, without thousands of kids in line for surgery.

Before I worked for PLC that summer, I let myself live small stories that took little imagination. I expected my life to be like everyone else’s, without real risk, without adventure. But PLC showed me how to have an imagination, to dream up a better world for others and for myself.

Now, as I’m graduate-school bound (“real world” bound, as I say), I know that imagination will save me from living a self-centered life. Imagination will turn me into a person like the PLC staff and the doctors and the business people I met in Iraq, dedicated to changing the world—and able to.

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You can read more musings by Lauren on her blog. Come back next week and we’ll introduce you to our new summer interns—can’t wait!

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.

Congress Clothing, Selling Shirts & Saving Lives!

May 15, 2012 by matt · Leave a Comment 

Congress Clothing is at it again.

Last year they donated a percentage of their profits and gave enough to save a child’s life, and now they’re doing it again!

I sometimes hear people say things like “I wish my work could help people like yours” and I always point them to businesses like Congress. These people saved a life by selling shirts and shoes! Check out their store by visiting here, or why not use your own business to save lives?

Write us and let us dream about it with you!

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.

My Take—The Real Meaning of Mother’s Day

May 13, 2012 by matt · Leave a Comment 

We’re deviating from our typical Tuesday-Thursday regimen to bring you a Mother’s Day guest post by the excellent Kristine Brite McCormick.

Kristine is an advocate and activist based in Indiana, and she is responsible for many of the lifesaving operations we’ve provided over the years. Take a few minutes to read her story:

This Sunday will mark my fourth Mother’s Day. I have not held my baby in my arms for any of them.

I was pregnant Mother’s Day 2009. I got cards from my husband and mother, and thought about the next year when I’d wake up to a baby and be a “real mother.” My perception of a real mother was so off. In November, I gave birth to Cora, and she was perfect. Except I didn’t know she was born with a broken heart—congenital heart disease.

She died suddenly and unexpectedly only five days later. The last two Mother’s Days have been spent wishing I could hide from the day’s barrage of images of “perfect families.”

For too many mothers across the globe, Mother’s Day is spent not holding our babies, but visiting their grave stone, or in the hospital willing them to get better.

In Iraq, Mother’s Day for thousands of moms means knowing their child’s heart is a ticking time bomb. With every pump of blood, their child’s heart becomes a little more weakened. Without lifesaving surgery, they will die. It’s a fact, this will be the last Mother’s Day for hundreds of Iraqi mothers to hold their babies.

I won’t ever hold my daughter again. Instead, I throw all of my energy into hoping all moms see their babies become adults.

To the mothers sitting bedside in Iraq, hopelessly watching your child struggle, I’m glad the Preemptive Love Coalition is here. Hope is coming. It won’t come in time for all of you, but it’s coming. I promise to do everything I can to make it come faster, and I hope other moms will join me.

That’s the real meaning of Mother’s Day for me, working to make sure every mother gets to spend the day with her child, in the U.S., in Iraq, and across the world.

###

To see how Kristine is making lifesaving, legislative change on behalf of mothers, visit her website: www.KristineBrite.com

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.

We’re now on Instagram, and We Want to Connect with You!

May 10, 2012 by matt · Leave a Comment 

We’re only several years late to the Instagram party.

For those of you who aren’t familiar with Instagram, it’s a free photo-sharing program that has exploded in popularity over the last couple years.

We love it because the new Facebook integration makes it easier to connect you with the Iraqi children you love. We can snap a photo right there in the hospital—*click*—and put it right in front of you in real-time!

We’ll also use Instagram to show you a side of Iraq that you’ve probably never seen before: weddings, goat-head soup, picnics, and anything else culturally unique that we encounter in our quest to establish surgical centers and save lives here in this great country. See our photos by connecting with us on Facebook or by searching our username in Instagram: preemptivelove.

And if all this integration-program-real-time gobbledygook has you confused, just keep reading. The strip below is from The Oatmeal, and it explains recent Instagram news well:

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.

Hussain: The Good News & The Sad

May 8, 2012 by matt · Leave a Comment 

Friends, Hussain’s surgery has been post-poned. That’s the sad news. Our lead surgeon’s foot is injured, and he needs surgery and rest. As discouraging as this is, it’s for the best because it will allow our surgeon to fully heal and then provide Hussain with even better treatment.

Now for the good news: Our goal for Hussain is 75% complete—we just lack $1,000!

Will you help Hussain make it to the finish line by donating toward his surgery? If just a handful of you give $10 and $15 gifts, he’ll be there. And anything you give beyond that goal will go toward helping other children at the next Remedy Mission.

It’s discouraging that something as small as a foot injury can keep Hussain and his friends from surgery, but we believe Hussain is worth the wait. Please continue to pray for Hussain and to wait for his healing with us.

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.

Failure Report: Year 2011 (Part 1 of 3)

May 3, 2012 by Jeremy · Leave a Comment 

The only bad failure
is the one from which we fail to learn.

Most organizations put a premium on celebrating successes at the end of every year—we certainly do!

But we also believe that we have a great deal to learn from our failures, so we endeavor to share them and the lessons we’ve learned in hopes of avoiding those same mistakes in the future.

When seeking to tackle intractable problems in an environment like Iraq, missed opportunities, missteps, false starts, and failures are par-for-the-course. There will be no improvement in the political situation in Iraq, in the economy, in healthcare, or in the pursuit of peace without a number of flops and failures along the journey. If we already knew what worked, we all would’ve implemented it by now and moved on.

The truth is, neither the American government nor the Iraqi—neither international nor local NGOs—truly know what works in Iraq. Most of us are making educated guesses and seeking to rightly adapt programs and principles that have proven successful at other times in Iraq or in other parts of the world.

From this point forward, I want to provide you with an annual (and sometimes real-time) assessment of our failures. In absence of such previous reports, I will use a few minutes to highlight our most meaningful setbacks, failures and lessons learned to date.

The three major failures of 2011, to be covered in this report are:

Let’s get started…

Failure #1: Leadership Indecisiveness on the Case of Six-Year-old Yahya

This was a major lesson in leadership that potentially affects every area of our organizational and team life, couched in the saga of one very specific family.

I was walking home from work one night in Iraq in early 2010, when my phone rang. On the other end of the line was a man, knocking on the door back at my office, in hopes of meeting me and presenting the case of his nephew, Yahya, to me for surgical consideration. 

I asked if we could meet tomorrow, but he was insistent and there seemed to be great urgency in his voice. Instead of postponing the meeting, I gave him directions to my home and met with him over tea.

From early on, the situation was less than ideal. Yahya had already received one charitable heart surgery and the second one that was being requested was bound to be difficult.

In our 2007-2010 Failure Report, I noted our decision to restrict the complexity of children we sent abroad for surgery after a series of deaths caused us to reconsider our risk tolerance. Yahya was definitely on the high end of our new risk tolerance.

I chose to refuse surgery to the family based on our new priorities.

Months later, after a new check-up, Yahya’s mother and father brought him into our office to inquire again about the possibility of surgery. I’ll never forget sitting with them in my office explaining our decision to decline surgery funding for Yahya.

Then, with all the persistence that you would expect from a mother, she appealed to me again not to turn away their little boy.

I think one thing that non-profit directors and program directors fail to say often enough is this: “I am a human. I’m swayed by the kindness or brashness of our patients and, at times, it heavily influences how I make selection decisions.”

I could not continue to say “no” any longer. I said “yes” (with conditions).

Our surgeon in Istanbul was clear from the beginning that his surgery would require a “valved conduit” (an additional $5,000 expense or more) and licensing agreements in Turkey at the time had caused a shortage of such devices.

Cody Fisher (Development Director) did a great job reaching an agreement with Medtronic providing Yahya with a donated conduit, but the timing of receiving the conduit was still beholden to the licensing agreements that were being worked out in Istanbul.

All these factors together ultimately led to Yahya missing our July 2010 surgery group to Istanbul. We refunded the family’s portion of the money they had contributed for his surgery.

Shortly thereafter, in August 2010, we conducted our first Remedy Mission inside Iraq—our new programatic focus on localized training and development. The mission was such a huge success, I became convinced that we needed to cease all funding for outside surgeries and focus solely on development work inside the country.

But I also felt a sense of commitment to Yahya and his family, who were basically caught in the transitional period between one programatic focus and another.

What I should have done at that point was send Yahya to surgery in Turkey, finish our commitments there, take the free valved conduit from Medtronic, and finish our work in Turkey strongly. What I did instead was place Yahya on an upcoming Remedy Mission and take the Turkey option off the table for the family.

What I didn’t account for very well in that decision was how the complexity of Yahya’s case would fare in a development setting; a setting in which local capacity was far below that which he would have received in Istanbul.

In the chaos of Remedy Mission IV, a number of things went badly. Among them, Yahya’s family probably did not receive the proper explanations that they should have about the risks of his surgery and they probably felt very vulnerable about the decision to go forward with the risky surgery or forever miss their opportunity.

It was difficult to assess all this in real time, in part because I was so hopeful for Yahya and his family. In my optimism, I did not see or recognize a few red flags. But even that is not the whole truth… I remember hesitations—“red flags”—even as I sit here today. I willingly suppressed anything that was not hopeful and optimistic. It seemed noble, brave and right.

But he wasn’t my child.

Yahya’s surgery presented many complications that ultimately required doctors to operate through the night. When Yahya arrived in ICU around 5 or 6 a.m. the next morning, he was deemed stable enough for the surgical team to go to the hotel for a few hours of sleep. Before their bus even arrived at the hotel, though, Yahya had passed away in ICU.

I would not normally include a single death in a year-end Failure Report. My point is not that I feel bad and need catharsis. It’s just that Yahya was different, and not only because he had a name or because his family hosted us for dessert in their home and shared tea in mine. No, Yahya was different because I flipped-flopped on the family so many times. I said “no.” Then “yes.” Then “no” again. And then “yes.” And then he died.

Organizationally, the failure was related to a lesson we were just beginning to identify in our 2007-10 Failure Report: we are not the best qualified to select children for surgery. The suggested way forward at that time is still right: we have handed child selection over to a committee of local healthcare providers and our international surgical team. There will still be deaths that we regret deeply, but they will be less a function of our role and influence in the child selection process.

Personally, the failure was related to my inability to make a decision and stick with it. I always had a bad feeling about Yahya’s likelihood to endure surgery. That was why I denied funding more than a year prior to his death. I had good reason to deny funding. But I went back on my hunch. Fair enough… I wanted to give a family a chance. But I never really got over my fears of his death and that made me unwilling to go all in with the family. I hedged over spending extra money on his expensive valved conduit. And even when the conduit was donated, I found other reasons to delay surgery for fear of spending a lot of money (including the family’s) on a surgery about which I was always suspicious.

Lessons Learned: 


1. It’s OK to change one’s mind; but a leadership “Yes” or “No” should mean something. It hurts everyone involved to say one thing, give the impression of support, and never fully get behind one’s own decision. In this case, it played a role in Yahya’s death. 

He may have died in Istanbul just the same. The death itself is not the failure here. The faulty, character-flawed process by which I made life-altering decisions is.

I said “no.” I should have stood my ground. Or I said “yes” and I should have given that family my fullest “yes” ever. Instead, I said “yes” and stayed on the fence. I won’t do that again.

2. We are not qualified to select children. We are too emotionally attached and we do not possess the knowledge to make a right decision about a patient’s candidacy for surgery. We have handed child selection over to a collaboration between local cardiologists and our international surgical teams.

If you have any questions or concerns about this report, the decisions we’ve made, or the direction we are going, please email me at your convenience. I would love to hear from you.

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.

Hussain, or John Wayne?—See Him Play Cowboy With His Doctors!

May 1, 2012 by matt · Leave a Comment 

Have you picked up on how much Hussain enjoys playing around yet? This was a short video clip from the first time I met this boy.

To track his progress and to interact with Hussain online, check out Hussain’s party page. You can leave him a note and we’ll show it to him once we’re in the hospital! Make a short video, craft a poster, or get the kids together to color Hussain with a new heart. Click here to connect with him now!

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.

“A Girl Called Iba”—A Documentary About Honor & Shame

April 26, 2012 by matt · Leave a Comment 

Former short-term staff member Lydia O’Neil just released her documentary from her time in Kurdistan! In it, she takes a behind-the-scenes look at what Kurdish girls really think about boys, family-expectations, and shame. Check it out!

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.

Watch Our Animated Manifesto!

April 24, 2012 by matt · Leave a Comment 

Over the last few months we’ve seen an incredible influx of new readers and supporters, so it seemed good to put our most informative and successful video to-date back on the blog.

Whether you’re brand new or if you’ve been here a hundred times, watch it and let me know your reaction. Is it naive? Spot-on? Over-the-top? Email me!

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.

A Glance Back, A Long Look Forward

April 19, 2012 by matt · Leave a Comment 

I’m sure this has never happened to you, but today I got distracted at work…

I blame the internet (read: Twitter) for being so interesting. But at least it was a semi-productive kind of distracted; I started reading back through some of the very first posts on this blog, written by Jeremy way back in the day.

This was back when we still emphasized our Buy Shoes. Save Lives. program, and Jeremy ended a few of the emails with quirky phrases like “shod thyself” and signed off with some pretty epic monikers like “the rad-ifier” (someone who makes things rad, obviously) and “the wristbandits,” just to name a couple.

But all this rabbit-trailing was a great reminder of PLC’s history and what you have made possible! Some of you have faithfully read this blog for years. You’ve been with us through serious tragedy, and sky-high elation. You stuck with us when we failed (and wrote about it in-detail) and when we transitioned to our current Remedy Mission model.

You rooted us on back when this was all just a big, beautiful mess-of-an-idea. You believed in us, and I hope you know how grateful we are for it.

PLC turned 4 years-old last February, and that quick look back at our history reminded me how much further we have to go. By the end of the year we’ll be developing heart centers in 5 cities across the country—great news, right!? But the key word there is ‘developing,’ because these centers will likely take 5-8 years before they’re fully independent and self-sustaining.

So we need you to stick with us, to keep reading, and to remember that this won’t happen without you. Countless thousands of children are still waiting, and countless thousands will be saved if we can just keep moving and looking forward together.

With you to the end,

The Rad-ifier

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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