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)

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.

“An Idea Worth Living”—Hear Jeremy Courtney Speak At TEDxAustin!

April 12, 2012 by matt · Leave a Comment 

“If we live skeptically and only by the principles of risk-management, I fear we’ll miss the opportunity to remake the world around us.”

On a recent trans-atlantic trip, Jeremy Courtney was invited to share about the concept of preemptive love at TEDxAustin’s 4th annual conference.

This talk differed from his TEDxBaghdad talk as he shared new stories and invited attendees to consider how they personally might “do preemptive love.” And the video presents the same question to you: what can you do—small or large—to remake the world today?

After watching the video, would you share it? Your ‘shares’ and support help make our work possible—they can help save lives!

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.

Hope for Baby Bakir and His Ruined Hometown

November 15, 2010 by matt · 2 Comments 

Meet Baby Bakir (pronounced bah-ker). Thanks to the combined efforts of Nahoko Takato, the talented doctors and nurses at Anadolu Medical Center, and the Preemptive Love Coalition, this beautiful little boy is now recovering after receiving a lifesaving heart surgery in Istanbul, Turkey.

This is actually an exciting week for Bakir’s hometown of Fallujah as it’s the first annual Remember Fallujah Week. US veteran Ross Caputi launched the Justice for Fallujah Project to decry the atrocities committed against the citizens of Fallujah during the Iraq War.

US officials report that more than half of the city’s 39,000 homes were either damaged or destroyed in Operation Phantom Fury in 2004, and, like Bakir, many of the city’s children have continued to experience the lingering effects of chemical weapons in the form deadly heart defects.

Yet in the midst of so much destruction, we’re eager to offer you stories like Bakir’s. In a city of rubble, his is a bright story of hope and future.

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.

Jeen and Chro Head Back to Iraq with Healthy, Happy Hearts

August 10, 2010 by Jeremy · Leave a Comment 

It has been a long two weeks for Jeen and Chro (and their guardians) as they’ve both waiting for surgery and taken a slightly longer recovery course than the others, but their day has come and we are filled with joy! All the work has paid off for these two as they are discharged with “fit to fly” reports for their Tuesday flight to Iraq where they will be received by extended family and welcomed home into a deluge of kindness and spoiling attention!

Their departure marks the end of another successful surgery group for us and that means you have now helped 62 children receive the urgently needed heart surgery that they so desperately needed. All 62 of these children you’ve helped needed to travel outside of Iraq for surgery – a stressful journey separated from family, in a foreign culture, full of difficulties that extend beyond an already difficult situation. But with our Remedy Mission on August 15th, we are changing that when we begin facilitating surgeries inside Iraq for the first time.

Over the course of two weeks Remedy Mission will serve up to thirty children who would otherwise die without treatment. For the first time we will be able to save lives in a way that maximizes your investment, trains local doctors for the future, and invests deeply into the future of Iraq.

We cannot save lives without you. If you like what we do, please take three minutes to become a monthly sponsor and saves lives every month.

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.

Dad Beams with Pride as Nivar Enjoys Her Healthy, Happy Heart at Home in Iraq After Surgery

August 7, 2010 by Jeremy · Leave a Comment 

photo by Heber Vega

On July 18th Nivar left Iraq in urgent need of a lifesaving heart surgery. In the airport that day she almost passed out numerous times. We have known of children with heart defects dying in the airport on their way to surgery. It was a scary time.

Today Nivar is back at home in Iraq with a healthy, happy heart because of you! Her surgery on July 20th resulted in a total correction. And, of somewhere along the way she captured our hearts and the attention of thousands around the world!

If you are looking for change you can believe in, you don’t need to look any further than Nivar. She was a happy child at risk of losing her life when we met her. Within just a few weeks you came together to provide the money she needed for a lifesaving heart surgery. And now you have enabled her to be at home enjoying her newborn baby sister, playing soccer outside with her brother, and ready to start up school again with greater focus and energy in the Fall!

Wouldn’t it be nice to make that kind of impact every month? Wouldn’t it be great to go to work each day with a child like Nivar in mind as a way to focus on something greater than your job?

Why not become a monthly sponsor and join us in the biggest impact gift you can for kids in Iraq?

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.

American Donor & Volunteer Shares From Front Lines of our Work in Iraq & Turkey

August 6, 2010 by Timothy · Leave a Comment 

Have you ever observed something that made you feel just a little more alive than you did the second before? The senses sharpen, everything else around you stops, and it seems as if the state of your very existence could hinge upon your understanding of that precise moment. Life all of a sudden becomes more valuable and hope of something unintelligible, unexplainable and far off fills your being from deep within.

That is how I felt when I dodged a father running to see his daughter’s doctor following the completion of her open heart surgery. His wait to see his daughter was not quite over, yet as I dodged out of his way it was obvious that any news was the most important thing in the world to a helpless father who could do nothing to rescue his daughter from an unseen foe.

There were honestly a few moments that rivaled this one during my short three days spent at Anadolu Medical Center with the Preemptive Love Coalition. When the constant issue at hand is that of life and death, the meaning of both is unavoidable. Although I’ve followed and supported PLC for three years now, the personal interaction with the children heading to surgery and their parents was a gift I was not quite prepared for. As I sat outside at the hospital coffee shop with Nivar’s father, still waiting to see his daughter for the first time since surgery, I could feel the anxiety and helplessness surrounding him and was reminded of the gift of loved ones. Every healed heart at Anadolu Medical Center is a child saved, a future restored and also a family preserved.

One of the greatest blessings in working with, giving to and supporting an organization like PLC is the knowledge that what you are doing is truly meaningful. And let me tell you partners, supporters, donors and friends of PLC, your investments and partnerships are truly worthwhile! Your efforts and funds go directly into saving childrens lives, preserving families and renewing futures. From all over the world, you are affecting lives of real people for the better. I’ve seen it. And these people are thankful.

One particular issue that was brought to light during my week with my friends at PLC was that ethnic struggles do not have to result in war, racism or death. Addressing ethnic and religious tensions can also result in life, in reconciliation, in hope for the future. For every political struggle that takes place in order to get a Iraqi child to a successful surgery in Turkey, there is also a celebration of life, a reconciliation of enemies, and a hope of a child’s future reborn.

Finally, it seems the shared response from all parties involved is one of doxology, “thanks be to God.” That is truly amazing, and it is something I will always choose to be behind.

This little boy, Yahya, still needs a few thousand dollars to cover the costs of surgery and travel from Iraq to Istanbul so he can experience the same life-change you’ve given Nivar. To take Yahya out of line and get him to Istanbul for surgery, please enter the amount of your choice below and click “Donate Now!”.

Follow Nivar on Twitter: @NivarMohammed. Subscribe to Nivar’s updates via RSS HERE. Follow Nivar’s thread of longer stories (with pictures & video) on the PLC blog HERE.

Tim Mason is a friend and supporter of PLC who works with college students in Waco, Texas. Some of his greatest joys include learning, giving people second chances, playing any sport imaginable, and drinking chocolate milkshakes.

Jeen’s Surgery is a Total Correction After Doctors Work Until 4 a.m. on Failed Catheter Correction

August 3, 2010 by Jeremy · 6 Comments 

It has been a rough week for Jeen Mustafa. Her loving sister brought her outside of Iraq by donating her life-savings to PLC in hopes of procuring for her sister a non-invasive correction for her relatively simple heart defect. Simple does not mean unimportant, however; especially when it is your sister. Jeen would have never risen to the top of our charitable surgery list because her situation was neither urgent nor listed as complicated enough to warrant surgery outside of Iraq’s extremely new surgery industry. So, in an attempt to heal Jeen, her sister offered to pay the entire amount if we had the space and time to heal her sister without displacing another child. We were happy to help and grateful to all the staff and doctors at the Anadolu Medical Center for making this a reality.

We remain committed to helping children who cannot get help inside Iraq, and we draw our cues from the governments with whom we work and from local cardiologists. If they tell us a surgery cannot be performed in country, then we consider that child for placement outside. Thankfully, local adult cardiac surgeons across the country are starting to make forays into pediatric surgery. To be precise, they are vastly different. But we are thrilled to see local surgeons eager for training and upgrading, such as that we are seeking to provide with our Remedy Mission in a few weeks.

Back to Jeen, it was very important to her sister that we pursue for her a non-invasive trans-catheter closure correction in which a catheter and umbrella-type closure device is inserted through the thigh, into the heart, and expanded and attached to the walls of the heart to close the hole that is currently causing her problems as she enters young-womanhood and anticipates marriage and children in the next decade. We ordered the closure device with her sister’s money, and the staff at Anadolu Medical worked overtime upon overtime until 4 a.m. to attach the device non-invasively by catheter. Unfortunately, it ultimately proved impossible and unsafe to settle for that correction and surgery was scheduled.

Surgery was not in the plan and not in the budget. But Dr. Sertaç Çiçek in his continued graciousness and kindness to the children of Iraq agreed for his team to perform surgery pro bono to compensate for the drama and disappointment. Surgery is exactly what they had been trying to avoid. The risk; the recovery; the scars – these were all the things they sought to avoid. But scared and heartbroken Jeen went into surgery to correct the TWO holes in her heart that were revealed during the diagnostic testing.

A few hours later Jeen emerged from surgery with a total correction. It was not the way we had anticipated. But a total correction is a total correction! She has a scar, but she no longer needs to fear marriage and child-birth as a death sentence. She can walk to school with her girlfriends without tiring. She can pay attention and pursue her education and her impressive English-learning without distraction.

And that scar? We think it will stand as a testament to the kindness of the Turkish team that worked for more than they had to and gave far more than was expected to serve a Kurdish child whose family risked it all at the hands of the Turks; the same Turks that some of their neighbors on the Iraq-Turkey border can only see as enemies are the very Turks who saved her life. And this is just the sort of kindness and compassion we’ve seen repeatedly by Dr. Sertaç Çiçek, his entire team, and those in charge of nursing and administration at the Anadolu Medical Center in Istanbul, Turkey.

Follow Jeen on Twitter: @JeenMustafa. Subscribe to Jeen’s updates via RSS HERE.

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.

Chro’s Heart Surgery Results in Total Correction and Alleviated Fears for Pregnant Mom

July 28, 2010 by Jeremy · 1 Comment 

Chro went to surgery on Tuesday after being rescheduled due to an emergency surgery in the ICU for another child last Friday. The surgery was ruled a “total correction” by the surgical team, much to the relief of her pregnant mother and family back in Iraq.

The next major step is extubation… Stay tuned for more updates on Chro’s amazing progress thanks to you!

Follow Chro on Twitter: @ChroArkan. Subscribe to Chro’s updates via RSS HERE. Follow Chro’s thread of longer stories (with pictures & video) on the PLC blog HERE.

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.

Leah Is Clear to Fly Home to Iraq on Saturday with a Healthy Heart

July 28, 2010 by Jeremy · Leave a Comment 

It has been amazing to see the transformation in Leah’s mother this week as she has gone from terrified at the prospect of entering Turkey and handing her daughter over to Turkish doctors for heart surgery to joyful and excited Leah’s progress, at peace with her Turkish nurses and doctors, and ready to get home to Iraq with her healthy, happy bundle of joy!

Special thanks to Brin Wisdom for her dedicated advocacy and fundraising for Leah. Brin, her friends, and all the rest of you who have given have changed this family’s life forever!

Follow Leah on Twitter: @Leahibrahim. Subscribe to Leah’s updates via RSS HERE. Follow Leah’s thread of longer stories (with pictures & video) on the PLC blog HERE.

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.

Chro Goes Into Surgery After Delay & Rescheduling Late Last Week

July 28, 2010 by Jeremy · Leave a Comment 

Chro’s mom finally sees the beginning of the end to her worry and anxiety as she sends her little girl into surgery at the Anadolu Medical Center.

Follow Chro on Twitter: @ChroArkan. Subscribe to Chro’s updates via RSS HERE. Follow Chro’s thread of longer stories (with pictures & video) on the PLC blog HERE.

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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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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