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)

In A Word: “Neighbors”

December 7, 2011 by matt · Leave a Comment 

Haka ta nazani, chava da jeerani.
-Kurdish proverb

Translation: “If you don’t know, look to your neighbor.”

Photo by Jamal Penjweny

As PLC's Press Secretary, Matt Willingham is bent on leveraging words and media to connect hearts and minds to Iraqi children in need. On the side, he likes reading old books, devouring the great food his wife cooks up and dabbling in DSLR video work. He's also mildly obsessed with Twitter: @mehtin.

In A Word: “Mend”

November 30, 2011 by Lydia · Leave a Comment 

To see more by Polish artist/cartoonist Pawel Kuczynski, go here.

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

In A Word: “Thanksgiving”

November 23, 2011 by Lydia · Leave a Comment 

Miles outside of Sulaymaniyah, a man gives thanks and prays as the sun sets behind him.

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

An Interview With Artist Ben Hodson (And A Video Of His Work)

September 3, 2011 by matt · 2 Comments 

Last month we introduced you to a piece by Ben Hodson, and some of you responded wanting to know more. So Ben shared this video with us documenting how he made the Amna Suraka photomontage.

(HINT: While you’re waiting for the video to load, check out the short interview with Ben below!)

PLC: Start with a little background. What influenced you toward becoming an artist?

Ben: I was born in Brighton, UK into a family with a painter for a mother and a creative entrepreneur for a father. They inspired me to creatively look for solutions to the world’s issues. I moved around a fair bit as a child and even lived in India for a couple of years. These experiences greatly influenced my outlook on life and how I appreciate and view other cultures.

PLC: So where did your interest in Iraq come from? Were you previously interested in Kurdistan before traveling there?

Ben: I have an interest in people–especially people who have a story to tell. The Kurdish and Iraqi stories are surely some of the most defining stories of the 20th and 21st centuries. I have always had an interest in travel and new cultures, and the Middle East has a very hospitable and family-oriented culture, which I like. I also love Kebabs!

PLC: What kind of response have you had to this Amna Suraka piece from Kurds and Brits? Did the exhibit get a good turnout?

Ben: Initially, Kurdish people didn’t respond well to anything with the word “Iraq” in it, but as soon as I spoke to them and explained the relevance and how this draws Brits and Europeans in, they were very positive. It’s a story that most of the West has not heard.

The response [at the exhibit] was very good, hundreds of visitors came to the show, we got numerous feedback comments, we had local and regional press coverage and the curator of the gallery said to me that it was the best show they had ever put on.

PLC: Lastly, would you tell us a little about your work in general and what visual peacemaking means to you?

Ben: I’m interested in ideas of storytelling, narrative, place and location. This is why I went to Iraq. I went looking to explore the story of the Iraq still unseen, to engage with the lives, questions and challenges the media has been ignoring. Though I wanted to tell their story, I soon realised that I could not do this as well as the Iraqi people themselves.

I am not a photojournalist, I do not hunt down the headlines or stop myself getting involved. I am interested in the people, their lives and their stories. I cannot expect people to be affected by what I show them without first allowing my own heart to be broken by what I experienced.

For me, visual peacemaking is about using our creativity to bring about positive change in the world. Specifically bringing peace through all visual means, not just photography.  I am an artist, the photography and filmmaking is only part of what I do. Visual Peacemaking could be done through actually showing art; maybe a documentary, an exhibition of art by a misunderstood community, a series of photographs or even a piece of sculpture or installation art.  This of course embraces the beauty and common humanity of other cultures, but it also may be in finding healing/understanding in our differences and past hurts.

You can check out more of Ben’s work on his personal website HERE. Thanks for reading!

As PLC's Press Secretary, Matt Willingham is bent on leveraging words and media to connect hearts and minds to Iraqi children in need. On the side, he likes reading old books, devouring the great food his wife cooks up and dabbling in DSLR video work. He's also mildly obsessed with Twitter: @mehtin.

In a Word: “Angel Veins”

August 3, 2011 by matt · 3 Comments 

“The human heart stripped of fat and muscle, with just the angel veins exposed.”

credit: hotcupsoftea

As PLC's Press Secretary, Matt Willingham is bent on leveraging words and media to connect hearts and minds to Iraqi children in need. On the side, he likes reading old books, devouring the great food his wife cooks up and dabbling in DSLR video work. He's also mildly obsessed with Twitter: @mehtin.

In A Word: “Daily Square”

July 7, 2011 by Lydia · 1 Comment 

The Daily Square is a compilation of photos from Remedy Mission VI in southern Iraq. For more Daily Squares, check out PLC’s Facebook page.

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

Stepping Back And Looking Forward

December 13, 2010 by Cody · Leave a Comment 

It’s not everyday you go to a place where they say it all began.

A place where they say the Garden of Eden might have been, where Abraham lived, where civilization sprung up along with architecture and the invention of the wheel.

We spent the day outside of the hospital, canoeing through the marshes on the Tigris River and meeting with local sheikh’s, eating lamb, drinking tea, and standing on the roof of the site that Abraham called home.

It was a complicated picture though, with military on every corner, and an AK-47 jammed in between the driver’s seat and mine.

Imagine trying to close your eyes and picture the Garden of Eden when police sirens and car horns continually bring every thought into submission.

It was a good change, to be out of the hospital and instead of talking about the future and trying to cast a vision for healthcare, to instead listen and hear about the history of the land we’ve stepped into.

I found out that the man who directs our security once lived in the marshes we were canoeing through. His family fled there, like so many, to hide from Saddam Hussein and the Iraqi military. To save their lives they left their homes and cars for reed huts and canoes.

I also found out that some of the doctors and politicians we spent the day with were once revolutionaries who rallied local tribes and cities to resist the regime.

From the time Abraham left it seems like the people here have been in one epic struggle for tomorrow.

But since the fall of Saddam they’ve been able to devote their resources towards development rather than just survival. Now these sheikhs and revolutionaries are the leading voices in developing health care, strengthening the school systems, and building stronger ties within their local communities.

The Middle East is a complex culture built on honor and with each day that we’re here, we see how they continue to honor those who have gone before them and also those who are following close behind. They’ve sacrificed so much to have today and they continue to sacrifice for tomorrow.

As hard as it was to try to imagine the past today, we got glimpses here and there. Sometimes it’s just as difficult to try to imagine the future but with each surgery and with each story we hear, we get small glimpses that let us know this is all going to be worth it.

Cody Fisher is the co-founder and Development Director of the Preemptive Love Coalition. He moved to Iraq in 2007 where he met his wife and since then they've been waging peace and mending hearts across Iraq. His passions are photography, peacemaking, and food that doesn't come out of a can. You can follow him on Twitter: @candmfisher.

Photo of the Day

June 24, 2010 by Lydia · Leave a Comment 

Little Honya peeks out from behind her mother in the kitchen, so cute! This is from our most recent home visit with Honya, she is so healthy and happy!

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

Photo of the Day

June 16, 2010 by Lydia · Leave a Comment 

PLC interns have recently worked with local shoe makers to design the first-ever pair of female Klash! Here, a Klash-maker cuts ribbon for the bow, which is one feminine aspect of the new shoes. Pre-order a pair here for a limited time only.

www.buyshoessavelives.com

Lydia Bullock wrote and photographed for us during the 2010 summer internship and then again for 7 months in 2011. She documented surgical missions in northern and southern Iraq. See more of her excellent work on our Flickr stream, or follow her on Twitter: @lydiabullock.

Pondering Available Responses to Genocide and Its Effects

June 10, 2010 by Lauren · Leave a Comment 

On March 16, 1988, toward the end of the Iran-Iraq War, the Iraqi military used chemical weapons on the city of Halabja. The attack was meant to erase all Halabja inhabitants off the map: plants, animals and humans. A total of 5,000 men, women and children were killed in the attack, and of the survivors, 11,000 were injured.

As we walked through the memorial, I recalled an ancient Hebrew poem:

By the rivers of Babylon, we sat and wept
When we remembered Zion.
There on the poplars we hung our harps,
For there our captors asked us for songs,
Our tormentors demanded songs of joy

The poem is about the Hebrew people who were exiled in the land of Babylon, present-day Iraq. They cried because they missed their homeland; they cried because they were expected to be happy and play songs for their captors. But they couldn’t.

I wonder if that’s how the survivors of Halabja felt. They didn’t want to sing songs. Their families died. Their neighbors died. Like the Hebrews, some Iraqis living in Halabja had to leave their land and flee to Iran.

I’m trying to make sense of what happened in Halabja. I’m trying to make it mean something to me. We are bombarded with images of war and genocide on the news, making it easy to forget that Halabja was a reality. We forget that congenital birth defects caused by this and similar chemical attacks are a reality.

O, Daughter of Babylon, doomed to destruction,
happy is he who repays you
for what you have done to us

I hate how the Hebrew poem ends. Instead of offering hope for a people, it speaks of revenge against the tormentors. Hate is so easy. It is our job to choose not to hate.

Many children here need surgeries and medication and therapy to address their congenital birth defects. And some of them probably need this help as a result of the chemical attacks in Halabja and other attacks similar to it. As a newcomer and summer intern, I love that the Preemptive Love Coalition response to genocide is not to seek revenge on behalf of victims, but to work alongside Iraqis to bring healing to suffering children.

Mohammad’s family had $6,000 in-hand on loan from a friend to get their son the heart surgery he needed. Then the creditor decided to build a new house and took his loan back before Mohammad received surgery. Now the family is trying to find surgical solutions. Donate the amount of your choice by entering it in the field below to help send Mohammad to life-saving heart surgery.

Lauren Sawyer, a PLC summer intern ('10), is telling Preemptive Love’s story by managing its year-end review. Along with storytelling, Lauren loves reading 20th Century literature, listening to (good) music and chatting over a cup of coffee.

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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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