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)

Healthy Danar Can Now Experience New Life Because of His Lifesaving Heart Surgery

July 7, 2010 by Esther · Comments Off 

from Preemptive Love on Vimeo.

Since, his surgery in January, Danar has steadily regained his strength and has begun to have new life.

Danar is one of nearly 50 children who have undergone surgery with PLC. And it is because of your donations that he can run, laugh and share life with his family.

You can continue to make a lasting difference in the lives of children like Danar by donating to our Remedy Mission —  two weeks of partnering local doctors with international surgeons to provide 30 local heart surgeries for Iraqi children.

And we encourage you to share that spirit of making a difference with others —  creating a ripple of change amid your family, friends and co-workers in your circles of influence. By giving through Remedy Mission, buying Klash from our Buy Shoes. Save Lives. program, or creatively partnering with PLC to find new ways of providing these heart surgeries, you can show your community a glimpse of peace and hope in Iraq as it becomes reality for children like Danar.

Esther Perez, a PLC summer intern ('10), is spending this summer managing the daily blog and telling the stories of Iraqi children affected by congenital heart disease. The die-hard Texan loves spending her time learning local languages, talking about soccer and swimming.

Two Weeks Away From Surgery, Leah Continues to Grow and Develop

July 5, 2010 by Esther · Comments Off 

from Preemptive Love on Vimeo.

In a week and a half Baby Leah goes to surgery!

Those words bring so much joy to my heart because they signify the new life that successful heart surgery will give Leah.

Since the last time that we visited Leah, she has continued to grow and develop – rolling over with ease, bouncing off her mother’s lap, waving at others and attempting to hold herself up on her hands and knees.

This little girl, whose birth defects have threatened to steal her life away, now has the opportunity to have that life transformed because of the combined efforts of Turkish heart surgeons working to restore peace with their set of surgical tools along with the willingness of donors like you.

Leah is one of 4 Iraqi children that will be traveling to Turkey on July 18 for heart surgery because of your involvement and desire to combat the unnecessary deaths of children born with congenital heart disease.

Click HERE to follow Leah Ibrahim on Twitter as she gets ready for surgery.

Esther Perez, a PLC summer intern ('10), is spending this summer managing the daily blog and telling the stories of Iraqi children affected by congenital heart disease. The die-hard Texan loves spending her time learning local languages, talking about soccer and swimming.

A Bride-To-Be’s Handmade Shoes Knitting Together Two Communities

June 28, 2010 by Esther · Comments Off 

“I saw the shoes, and I fell in love with them instantly.”

Sounds like a typical statement that you would hear a bride bragging about the shoes she plans to wear on her wedding day, doesn’t it?

But for Debe Paul, her perfect shoes have an added meaning.

After the Ohio native saw photos of our new Ballet Klash on Facebook, she made a decision to wear them in her wedding this August. This new feminine shoe is the first we’ve made specifically for women with a slip-on design that is comfortable and cute but has an even greater significance.

“They’re absolutely adorable, but I love what it stands for,” Debe said.

On one of the most important days in her life Debe is devoted to “restoring relationships and communications with the Iraqi community,” as she put it.

It’s great to see our Buy Shoes. Save Lives. program successfully funding heart surgeries and introducing communities like Debe’s to real people in Iraq that would not otherwise know each other. Our lifesaving shoes are not only an important part of Debe’s wedding, they are a local source of revenue to fund heart surgeries for children in Iraq.

You, like Debe, can join us by purchasing a pair of shoes that will fund heart surgeries by clicking here.

Esther Perez, a PLC summer intern ('10), is spending this summer managing the daily blog and telling the stories of Iraqi children affected by congenital heart disease. The die-hard Texan loves spending her time learning local languages, talking about soccer and swimming.

Celebrating Fathers (Day)

June 20, 2010 by Esther · Comments Off 

For Abdul Kareem’s father, today may be his last Father’s Day.

Meet Abdul Kareem. This nine-month old’s family does not have the money to send him to surgery through conventional means outside the country.

Abdul Kareem is in a position where he must receive heart surgery before his first birthday or he will likely be inoperable because of increased complications.

You can make this Father’s Day more than just a holiday for Abdul Kareem’s family. You can help commemorate today as the day that Abdul Kareem receives the funds to go to surgery.

This August our Remedy Missions team of international surgeons will perform 30 heart surgeries and train local medical teams. This will give Abdul Kareem an opportunity to receive heart surgery in his own country that is both affordable and accessible.

But at this point that chance at surgery will only be possible with your donations.

A few days after the pictures above were taken, Abdul Kareem’s father returned to our office to talk to PLC Director Jeremy Courtney about the status of his son’s acceptance for surgery. And just as any dad in this situation, Abdul Kareem’s father pleaded “Just do something for him. He’s just a little boy.” He got so emotional that he excused himself from the conversation and the office. The father, who had done all he could for his son, walked away from the office crying.

Let this Father’s Day be more than gifts and family luncheons. Invest in surgeries that will help give children like Abdul Kareem a lifetime of celebrating days with their fathers.

Esther Perez, a PLC summer intern ('10), is spending this summer managing the daily blog and telling the stories of Iraqi children affected by congenital heart disease. The die-hard Texan loves spending her time learning local languages, talking about soccer and swimming.

A Call to Action for Remedy Missions in Iraq This Summer

June 14, 2010 by Esther · Comments Off 

“30 Kids in 30 Days!”

This rally cry has been heard in our office and seen on our website several times throughout the last month, but what exactly does it mean?

This August, the Preemptive Love Coalition is planning to partner with the International Children’s Heart Foundation to bring in both immediate and long-term life-saving opportunities to children in Iraq with congenital heart defects. We call these surgical training missions “Remedy Missions.”

These more localized forms of surgeries will make it easier for children to get to surgeries without having to travel to different countries, and will empower the local doctors to do more in their community.

In keeping the surgeries local, the excess time and money lost to applying for visas, buying plane tickets, packing, and other international travel plans are shaved off. In saving time and money, these localized missions will result in making heart surgeries more available to a wider range of people. In fact, PLC’s goal of seeing 30 children touched in 30 days, if realized, will mean that we help more children in the month of August than we did in the entire 2009 year.

Also, family members will be more accessible to provide love and support for these children who are going through the surgeries. Instead of outsourcing children and one of their family members, we are working to provide care in a familiar environment that will help entire families be part of working through the process together.

The Remedy Missions will not only focus on the immediate need for these dying children, but it will also enhance hope for the future of health care for congenital heart defects in Iraq. This summer world class doctors and nurses will be investing time into local doctors and nurses, giving them training that will make an impact on the people of this country for years to come. This training is so critical to the work being done in Iraq to help combat congenital heart defects because Iraqi cardiologists and surgeons often find it difficult to travel to other countries to learn from seminars and hands-on training. Still, this training is invaluable to them.

For us, the number 30 signifies more than just numbers to tack onto a list of successful heart surgeries or days spent trying to do something with the summer. These 30 are lives that are worth fighting for, worth giving for.

Treatment here is vastly different from that in America. In this country, families do not have the ability to go to the hospital and fix what is wrong with their dying son or daughter, even if they had the money. In the States, how would a father or mother react if, in the middle of the doctor’s visit, the doctor told them, “I’m sorry. Your child is dying. And there is a way to possibly save his life, but I do not know how to do that”?

Though there have been similar efforts, this is the first of its magnitude dealing with complex heart conditions in this area. As of today, we are still trying to raise over $50,000 to make these surgeries a reality. And with a June 19th deadline, we are looking at urgency. But if there are thousands of children dying of heart disease in this country, and there is a possibility of making a dent in that number, how can urgency not be part of the equation?

Esther Perez, a PLC summer intern ('10), is spending this summer managing the daily blog and telling the stories of Iraqi children affected by congenital heart disease. The die-hard Texan loves spending her time learning local languages, talking about soccer and swimming.

Leah’s Improvements Inspire Faith and Perseverance in PLC Family Advocates in Iraq

June 2, 2010 by Esther · Comments Off 

Last week I met Leah for the first time, and it was unforgettable. Leah is scheduled to leave with our next surgery group on July 18th. The beautiful green-eyed baby was the first Kurdish child I’ve interacted with since arriving for the PLC Summer Internship. I was blown away mostly because Leah taught me a lesson in faith when I was least expecting it.

Being a Down Syndrome baby with congenital heart disease, Leah has had to fight off the problems that both of those diseases have caused. This week, she’s winning.

Leah was hardly able to roll over at the last house visit, but Leah and her mom have been working on physical exercises designed to help build her muscles and after a month of pouring effort into improving her mobility the results were worth the wait. Leah began to show off some of those hard-earned skills by kicking her feet and cooing with rings in her mouth. Leah’s non-stop action included playing with her older sister, rolling to the other side of the room and back with incredible ease, and starting to prop herself up on her elbows while lying on her stomach.

It was beautiful to see that this little girl doesn’t know what it means to accept her current circumstances as her future reality. She is dying, and yet she continues to live out her life as it is right now – daily conquering the little things that stand in her way.

And although Leah has a hope of going to surgery and living a normal, healthy life, she’s oblivious to that. As a baby she doesn’t understand what any of that means, but she does know what it means to be tired of trying. And though she has undoubtedly felt tired, she pushes on.

And I started to think about how many times I limit myself when I feel overwhelmed with problems that seem too daunting to overcome. How many times do I focus on a problem to the point that I amplify it, instead of looking past it to a more desirable, attainable future?

For Baby Leah – and for all of us – obstacles exist to be overcome.

SHARE OF SURGICAL EXPENSE Enter the amount of your choice below to make a tax-deductible donation and get Leah on her way to lifesaving heart surgery this July.

Esther Perez, a PLC summer intern ('10), is spending this summer managing the daily blog and telling the stories of Iraqi children affected by congenital heart disease. The die-hard Texan loves spending her time learning local languages, talking about soccer and swimming.

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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 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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