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)

“Here, Insert This Wire Into My Heart!”—A Brief Look at Cardiac Development in Fallujah And Around the World

July 14, 2012 by Jeremy · Leave a Comment 

Unlike our previous nine Remedy Missions in the last two years, this Fallujah mission is the first time we’ve ever launched a heart center from scratch.

This center has just come into existence and is still years away from doing surgeries on its own. Instead, to ease their way in, they will begin with “cardiac catheterizations”—a method of treatment and diagnosis that requires a catheter sheath to be inserted into the heart through a small incision. Catheterizations were the first heart operations, first performed in 1929 by Werner Forssman (Forßmann), a guy who thought it would be a good idea to insert a wire into his arm and weave it through his circulatory system until he could feel the wire poking around inside his heart (he also had X-ray to help out). From there, the innovations have become even more amazing!

As diagnostics came to reveal more and more about the heart and children born with heart defects, catheterizations gave way to heart surgery and, eventually, “open heart surgery,” which requires that the heart and lungs be bypassed so that they can be “shut down” and operated on more safely. Of course, this was deemed blasphemous when it was first suggested and attempted: “Who do you think you are, God? Only God can stop the heart and bring it back to life!”

Open heart surgery has developed in its relatively young life to heal millions upon millions of broken hearts, but cardiac cath teams continue to demand attention, believing that many hearts can be mended without the risk and pain of open heart surgery.

Today, cardiologists work in tandem with surgeons to diagnose various problems through the same basic catheterizations that launched this field of medicine (only today they do it with incredibly sophisticated precision and science behind them). And cardiologists also heal many heart lesions in their own right through the insertion of devices that serve to “patch” holes or “balloon” passageways that are too narrow.

Much like the history of cardiology and cardiac surgery itself, the Fallujah program will go through a similar trajectory: cardiac caths will heal some of the “easier” children, eventually giving way to “closed heart”&mdashand then simpler “open heart”—surgery. Eventually, increasingly risky and innovative local surgery will come to rely more and more heavily on cardiac diagnostics.

A few of the Fallujah milestones since the day we arrived:

- Our team of 9 Americans is told we are the first unarmed Americans to visit Fallujah

- Fallujans fire up the cath lab for the very first time with two adult patients

- The first child (Beqas, pictured above) in the history of Anbar receives a diagnostic cath to determine her operability

- The first child (Sara) in the history of the Anbar province receives a cath operation that heals her heart

- Joint interviews with the press reveal underlying tensions about Americans but a solid commitment among our Fallujan partners to treat our team with great hospitality and welcome.

Come back tomorrow to hear more first-hand stories of your impact in Fallujah, and, if you haven’t already, please consider giving toward a pack of sutures. At $9 a pack, we just need 45 more packs before we’re fully equipped to mend little Iraqi hearts! Donate below.

Our 85 suture kits are FULLY funded — Thank you for helping fund $765 worth of medical supplies!

Our Partners:

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.

In A Word: After-Party

July 13, 2011 by Jeremy · 1 Comment 

Parzheen waited 5 years for a remedy, her surgery lasted a few hours, and her after-party will go on for a lifetime. Click on the video above to watch Parzheen’s journey from surgery to after-party!

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.

How Caring for Iraqi Children Made Me A Better Father

June 16, 2011 by Jeremy · 1 Comment 

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.

Why Father's Day Means So Much to Hafez And His Son

June 15, 2011 by Jeremy · 1 Comment 

At exactly this time last year, Hafez (pictured above) was facing down the worst Father’s Day of his life as he desperately worked against the clock to save his son’s life.

At exactly this time last year, we asked for your help… and you came through in a huge way, raising more than $30,000 in just a few weeks so we could launch our first-of-its-kind Remedy Mission inside Iraq.

At exactly this time last year, you made this father’s day and helped secure for him a happier life than the one he was facing without you.

Meet Abdul Kareem – the son of my friend, Hafez. When I met them, they did not have the money to pursue surgery outside of Iraq like all the rich people, people with political clout, or the lottery winners.

I’ll never forget Hafez’s plea to me – certainly the same plea I would make on behalf of my son – “Just do something for him. He’s just a little boy.” He got so emotional that he excused himself from my office. This father, having done all he could for his son, walked away from the office crying. Abdul Kareem needed heart surgery before his first birthday or he was likely to become entirely inoperable – “a lost cause.”

But you weren’t about to let that happen!

The day our surgical team arrived from all over the world for Remedy Mission I, Hafez must have seen us on the news because he called me ten times: “Is my boy going to surgery? Mr. Jeremy, just do something to help my little boy!”

His boy was going to surgery, thanks to those of you who gave in response to our request last year’s for Father’s Day and our Remedy Mission launch!

There is another moment with my friend Hafez that I won’t forget – the day his son Abdul Kareem had surgery. I remember it so distinctly because after the surgery Hafez grabbed me, kissed me, and gave me an

tearful “thank you” for keeping our word; for saving his son’s life.

Once Abdul Kareem was discharged to return home, Hafez sent me a message from the road. The message said something like, “Thank you so much for your organization and for helping my little boy. We will not forget you.“ With tears running down his face, he wanted to thank you each by name. You made a father’s dream come true. And you prevented his big brother, Abbas, from growing up without a soccer-buddy.

Dad, I love all the great memories we’ve made together. This year, I wanted to add, “saving a child’s life in Iraq” to the list, so that another child and his father can make great memories together too.

We want to make it easy for you to honor your dad this Father's Day and help save the life of baby Ghazel. A simple $10 donation will help us save her life and cover the cost of two hours of hands-on training with local Iraqi surgeons! A $25 donation will accomplish that and add hours of training in Iraq for an additional three Iraqi doctors and nurses! If you like, we'll even provide you with a free downloadable card that you can print and give to your dad this Father's Day!

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.

Have You Ever Seen How Much It Costs To Save 20 Lives? Here Are The Numbers:

June 6, 2011 by Jeremy · 1 Comment 

As we’ve looked across the landscape of organizations working in Iraq and around the world we’ve found ourselves wanting to know more about how their money is spent. We figure you are the same way – and we think you deserve to know. The scandalous press and allegations surrounding big name do-gooders, their books, and their organizations have all caused us at PLC to ask honest questions about how we can be fully transparent with you about your donations and our management of them in Iraq.

So here are a few real-time financial notes that will remain here for posterity’s sake:

- PLC spent $41,068.38 for airfare and hotels for Remedy V

- PLC spent $30,000 to the International Children’s Heart Foundation (ICHF) to procure their surgical expertise for this mission

- ICHF made approximately $20,000 in in-kind medical gifts to the mission (directly to the hospital in southern Iraq; not on our balance sheet)

- We have not finished tallying the field expenses for Remedy V yet but we anticipate it will account for an additional $1,790-$2,000

- Our partners in southern Iraq budgeted $1,500 for educational instruction

- More than $1,620 in visa expenses were covered directly by the Iraqi Ministry of Health (MOH) in Baghdad

- Security and transportation was provided to us, free of charge, by the MOH (worth, perhaps $10,000 as an in-kind contribution)

- Food, housing, and all local accommodations were provided by the MOH (worth more than $20,000 as an in-kind contribution)

We estimate the total cost of this particular mission to run all parties approximately $133,361. Our agreement with the MOH will subsidize approximately 77% of those costs, with roughly $2,800 for this particular mission coming from PLC’s international donor pool.

Our next mission – Remedy VI – in southern Iraq is scheduled for June 25th.

Here’s the bottom line to all this: you are indispensable to our work. We cannot help Iraqis reach their desired vision for the future without you. We cannot eradicate the backlog of untold thousands of children waiting in line for lifesaving heart surgery. And we cannot create the systems they need to do this work on their own without you.

But….

You are not alone! This is not a “hand-out” program in which you unload your hard-earned money into a foreign country (no matter how poor or decimated), without calling on local families, organizations, and government to carry the majority of the financial burden. This is what we mean when we talk about development. This is what we mean when we talk about graduating a program from foreign aid.

They cannot do it without you. But hopefully in the next few years that will no longer be true. Stay tuned in the coming months as we begin publicly exploring our EXIT STRATEGY and what exciting promises that holds for our dear friends here in Iraq!

With you,

Our Partners:

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.

“Martina Pavaníć is the best scrub nurse in the whole [wide] world.” – William Novick, M.D.

May 30, 2011 by Jeremy · 1 Comment 

That wasn’t the exact quote; the original was much more colorful and forceful! But the point is this: your financial investment in our Remedy Missions has helped us secure an amazing nurse for the operating room who is an incredibly capable administrator, leader, problem solver, and educator. In a pinch, she has the ability to play the role of Teaching First Assistant (to the lead surgeon).

We’re in the middle of Remedy Mission V, and even though most of the medical team turns over every mission with volunteers from all over the world, Martina is also on Remedy V. She has put in more hours of surgery and training across Iraq than any other single foreigner from anywhere in the world.

Martina was a recipient of this type of “humanitarian aid” or training back in her home country of Croatia when Dr. William Novick of the International Children’s Heart Foundation landed for a proto-Remedy Mission in 1993 and began training Croatians like Martina to be the remedy for their own children.

To hear Dr. Novick tell the story, Martina was very skittish and intimidated in the early days as a trainee in Zagreb, Croatia. “She would prepare the table incorrectly in the early days and I would send her home at the end of the day crying.”

After more than 15 years working alongside Dr. Novick in one form or another, it now takes a lot to make Martina cry. And she certainly knows how to prepare an operating room. If anything, Martina now sends others home crying and may well be the most intimidating force in the O.R.! I’ve personally left the O.R. more than once with my tail between my legs after crossing her sterile field or speaking too loudly in a way that distracted the training and surgery underway!

Once in South America an unexpected set of circumstances required Martina – a nurse – to walk a local surgeon through a highly complex surgery step-by-step “just like Dr. Novick does it.”

She knows her stuff!

Get a picture in your mind of Croatia in the early 1990s. Under-developed hospitals, atrophied education systems failing to adequately feed into the workforce, political in-fighting, limited access to medical supplies and resources, ethnic & civil war, and the world’s collective eye watching to see what would happen next.

It sounds like today’s Iraq!

The most inspiring thing to me about Martina is the way in which she epitomizes the ethos of our Remedy Mission approach. To simplify:

• 1) she needed training and resources
• 2) she received training and resources in her home country and helped save thousands of lives
• 3) now she travels the world training others and providing resources so they can serve their own children

The trainee has become the trainer; the aid recipient the reciprocator; the beneficiary the benefactor.

That, in my opinion, is preemptive love. Maybe she would have amounted to nothing in the medical field. Maybe she didn’t have the stomach for it. Maybe she didn’t look the part. Maybe Croatia was a bad bet back in the day. Maybe the problems seemed too intractable.

Preemptive love gave Martina wings. And Dr. Novick’s preemptive love in the 1993 is still creating shockwaves around the world today any time Martina scrubs in.

Will you invest today in tomorrow’s “Martina?”

Martina was able to learn, and now teach, because someone invested in her! Now you can invest in local nurses just like Martina by donating to our medical training program!

Our Partners:

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.

You’ve Sent Another Round of Remedy To Iraq

May 24, 2011 by Jeremy · Comments Off 

One of my favorite things about working for the Preemptive Love Coalition is the chance to stand before you every few weeks and give a transparent account as to how we are putting your hard-earned money to work in Iraq to benefit the thousands of children who are counting on us to help develop cardiac care on their behalf.

Today I’m back in southern Iraq, a few hours outside of Basra, for Remedy Mission V and it is such a joy! (Because we blog and Tweet in real-time we are withholding the name of the city to minimize any risk to our local and volunteer staff). In the last 8 months we have given more than 95 children a shot at lifesaving operations and invested more than 20,000 cumulative hours in both didactic and hands-on training for Iraqi doctors and nurses.

One of the most exciting things about Remedy V is the slower pace of surgeries and training. In a world where bigger and faster is usually better, I am really excited to slow things down this trip for the sake of greater learning and better results.

In past missions we took a faster pace, kicked the wheels of the system a little bit, stretched it to its limits and obtained a very clear sense for what was possible and what was not possible at this developmental juncture. With two full missions at this particular hospital under our belt we have more clarity than ever about how we should be proceeding. So the pace of surgeries on this mission, while slower than previous trips here, seems to be yielding exciting opportunities. Local Iraqis are working hard yet are also less stressed than previous trips because the pace and complexity of surgeries is more in line with their current developmental needs. Our volunteers from America, the United Kingdom and Europe are finding they have more time to teach in the down times between critical care.

And all of this amounts to more lives saved and better education for Iraqi doctors and nurses who are giving so fully of themselves to learn to care for children facing life-threatening heart defects.

Stay tuned this week for amazing stories of your life-changing donations hard at work!

Our Partners:

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.

Encouraging Words From a US Marine

May 15, 2011 by Jeremy · 2 Comments 

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

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

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

Parzheen Receives Total Correction; For Discharge from ICU Tomorrow

March 7, 2011 by Jeremy · Comments Off 

Parzheen went in yesterday for a total correction of four different heart problems and came through with spectacular results! She had her breathing tube removed within a few hours and her chest tube removed just shortly after that. She will likely be sent out of the critical care unit tomorrow where we will have a few more days in the ward to enjoy her amazing smile thanks to you!

Parzheen’s lifesaving surgery was made possible because of so many of you who have partnered with us through our Monthly Lifesaver program. We love our campaigns and fundraising pushes, but we benefit tremendously from those of you who quietly and faithfully invest every month into children like Parzheen.

We cannot always pre-select children in time to run massive fundraising campaigns in their names. We do not always have the capacity to create videos in advance of surgery. And not every child is your typical “poster child” mold.

Our community of Monthly Lifesavers gives us a steady budget each month that we can rely on to plan for future training and surgery Iraq.

Will you join our community of Monthly Lifesavers? Every bit helps. It’s the faithfulness of your monthly gift that makes this such a high-impact act of love for the children of Iraq.
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MONTHLY SPONSORSHIP Choose this option to give life to children every month for the amount of your choice (entered below). Your credit card will be billed each month without any additional work on your part.

If you’re on Twitter this week be sure to use the #RemedyMission hashtag to describe all the good news coming out of Iraq this week via @preemptivelove.



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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.

Death Will Never Conquer

March 4, 2011 by Jeremy · 5 Comments 

Yahya passed away early this morning after an all-night surgery. It was a surprise to everyone. When he was admitted to the ICU there seemed to be plenty of confidence that he would be just fine. But within just 30 minutes of admission his heart gave out and all efforts to revive him failed.

I still remember the first time I was introduced to Yahya. It was over a year ago. His uncle called my cell phone and said, “I’m at your office, I need to talk to you about a sick kid.”

It was after hours and I was already at home. But I could hear the urgency in his voice so I invited him to my home for tea. He arrived and made an impassioned plea for Yahya – his brother’s son. I was leery of helping Yahya after reading his reports – we had seen some children with complex heart defects like him die abroad and I couldn’t stand to put a family through that drama again. I did my best to avoid commitment and send Yahya’s uncle into the night without any solid hope for his nephew.

The following weeks were filled with phone calls and followup from the family, “Please help our boy!”

Finally, I met Yahya’s mom and dad and the little cutie himself. As they sat in my office they pled with humble urgency. They weren’t forceful. They weren’t rude. But they applied enough pressure on me that I couldn’t say “no” any longer. They made it abundantly clear that they understood the risk of his surgery and that they wanted it badly enough to endure whatever might come.

One of our core values as an organization is that we give “hope to the hopeless.” What that means is that we try to balance our impulse to be “last chance” people with our instinct to be “long-term” people. We held back on Yahya, wondering if it would give him long-term viability. But we ultimately dove in with Yahya’s family because we were their last chance. No one else would take on the risk.

We solidified this core value in November 2009 when we asked you what to do about a little boy named Ramyar. We asked you if you wanted us to apply your money in a high risk surgery or save it for a “sure thing.” You overwhelming said, “We want this Coalition to be about hope for the hopeless.”

We haven’t looked back since. We are the Last Chancers.

Still, committing to Yahya was full of complications. His surgery in Turkey was canceled due to an unavailability of an expensive assistant device. In fact, there was even discussion as to whether or not he should be included in our current Remedy Mission. Ultimately, we let the family themselves decide.

Our local cardiologist, along with our American surgeon, explained the risks of surgery, the option of waiting, etc. etc. Yahya’s dad was given a 50/50 chance of survival for little Yahya. Understandably, they wanted to give it a try. They couldn’t stand the risk of feeling like they had an opportunity to try and let it slip through their hands.

What would you have done? I have two kids – 5 and 3 years old. I have no idea what I would have done.

During Yahya’s surgery our Family Services Director, Jessica, sat down in the ward with all the parents whose kids were either in surgery or in critical condition in the ICU – those families whose kids were not “out of the woods” yet. As they asked questions about our organization and how long we’ve been working here, she recounted for them our past of taking children outside the country to significantly nicer hospitals than this Iraqi version in which we currently work. She told them about excellent American-trained Turkish doctors and fancy, pristine protocols abroad. Without fail, every family was so grateful for the chance to receive surgery at home. Let the Turks have their pristine hospital. “What if our child were to die abroad?” That would be a burden far too great to bear.

You gave Yahya’s family a chance that no one else would have. He had been rejected by every other opportunity out there. They are grateful to you. They will rest knowing they gave it their all for their only child.

And this is what we find almost universally – parents who just want a chance. And that’s what Remedy Missions are all about. We could continue to export kids to world class facilities, but who would invest in the future? We could continue to select the easiest children that almost never die, but does that make us any less culpable for the kids we pretend aren’t knocking on our door?

Was this a wasted opportunity? Did we waste the $670 that it cost us to provide Yahya surgery?

I used to feel that way when a child died in Turkey or Jordan or Jordan. I don’t feel that way anymore. Yahya’s death – though a terrible loss – was still an opportunity for local doctors to learn an innovative technique that they will be able to apply in future situations. His death was almost certainly unrelated to the particular tactic used in attempting to heal his heart. Educational gains always have significant costs. Before we only had the “we gave this child a chance” platitude. It’s not untrue. But local learning is an equally deep reason why your gift for Yahya made a difference.

Thank you for your willingness to stick with us through life and death. The gains that are needed here will not be made without significant risk and vision. We deeply appreciate your demand that we be the people of the last chance. I think it’s easier to sleep knowing we tried, than knowing we played it safe just so we could publish numbers and blog posts that seem more palatable.

With you,

Jeremy Courtney

Executive Director

email: http://scr.im/jcourt

+1 (806) 853-9131

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.

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	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 children in pursuit of peace between communities at odds. We offer the untold thousands of Iraqi kids 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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