1: What are you trying to accomplish?
2: What's your evidence that you can accomplish it?
3: How is it possible that you can provide an open heart surgery in Iraq for less than $1,000? Is that the full cost?
4: So is that the same thing as saying that my donation doesn't really make a difference? That the "up to 85%" funded locally by those inside Iraq is all that is really necessary to make this work?
5: Any other costs?
6: What is the bottleneck to more surgeries: money or skilled labor?
7: I'm skeptical of non-profits and charities because they always seem to be asking for more money. How can I be sure that Preemptive Love Coalition has "room for more funding" and that I'm not paying into a huge savings account, "Rainy Day Fund", or something similar?
8: Do you have enough volunteer surgeons available for unfunded Remedy Missions? (i.e., are there trips that you could fund if you had more money, or is there a labor bottleneck?)
9: Many heart surgeries require follow-up treatment (including additional surgeries). Do you have a way of providing these to patients?
10: How do you assess whether surgeries are completed competently and appropriately?
11: What is the rate of complications during and following surgery?
12: How do you assess whether surgeons are performing additional surgeries that they would have not had the funding or motivation to perform otherwise?
13: How do you assess whether surgeons are charging their patients for the surgeries you fund?
14: Do you follow up with the surgeons you've trained to assess whether they are correctly applying their training?
15: What information is available on the activities - and competence - of the surgeons you've trained?
16: Where do surgeons work after completing training? Do they serve poor patients?
17: How much do you spend each year on "program" expenses and how much on "overhead?"


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 Q: What are you trying to accomplish?

A: Train Iraqi heart surgeons and nurses so they can eradicate the backlog of tens of thousands of Iraqi children waiting in line for lifesaving heart surgery. [Back to Top]

 Q: What's your evidence that you can accomplish it?

A: Each year we continue to increase Iraq's total number of pediatric cardiac surgeries with new surgeries in Iraqi centers that would not - indeed could not - have been accomplished otherwise. Ministry of Health (MOH) officials speculate 500 surgeries were accomplished in 2009 (of which we provided 23 - 4.6% - outside the country). The addition of our 82 surgeries in FY 2010 - to the 500 baseline - for a total of 582 approximated surgeries, represents an increase created by PLC of 14% over 2009. In FY 2011 we anticipate increasing Iraq's total number of pediatric cardiac surgeries to at least 719 (or another 19% over FY 2010 directly attributable to our surgeons and our training).

Each year the local teams with which we work will become more proficient, and each year they will independently take on a larger case load than they could have the year before. None of these figures yet account for that additional output.

In March 2010 the Iraqi Ministry of Health asked us to expand our work to three additional sites. In May 2010 we began additional discussions about establishing a fellowship program in which international surgeons and nurses would take up residence in the Iraqi system to train locally for 40 weeks out of the year.

Our model does not rely strictly on volunteers because the level of need in Iraq outstrips what we could reasonably supply through volunteer labor alone. Accordingly, we set our budgets so as to actually contract the international surgical and nursing staff we need to accomplish our mission.

Sure, this increases the cost-per-mission (and thereby, cost-per-child) over early "mission" models in which volunteerism was idealized and training was not necessarily prioritized. But our contract labor + volunteerism model is inarguably the only way to create a nationwide quarterly training program and fellowships inside Iraq with international experts across approximately 6-8 surgical sites. Moreover, our model does not face the same sluggishness of learning that other surgery organizations suffer because we do not have the same rates of turnover; we have incredible consistency across our programs and missions. [Back to Top]

 Q: How is it possible that you can provide an open heart surgery in Iraq for less than $1,000? Is that the full cost?

A: The "less than $1k" numbers we routinely publish represent the amount in "program costs" we spend from our international donor money. The figure does not necessarily account for every single management, overhead, or fundraising expense.

Our total expenditures for FY 2010 were $188,919. We performed 82 surgeries during the same period for a per child total of $2,304 (though this data is a bit moot moving into 2010-11 as we abandon our very expensive "surgery exports" program(s) in Turkey, etc. and focus henceforth on more cost-effective in-country surgeries alone).

When all of our Remedy Mission partners are taken into consideration - including the Iraqi Government, medical companies that donate medicines and supplies, and local organizations - the real Remedy Mission cost to all donors is in the range of $5,400 - $7,000. Put another way, up to 85% of the total cost of a single surgical/training mission is now subsidized by local, Iraqi constituent institutions. [Back to Top]

 Q: So is that the same thing as saying that my donation doesn't really make a difference? That the "up to 85%" funded locally by those inside Iraq is all that is really necessary to make this work?

A: There is not a single site across Iraq for which our Remedy Missions are fully funded. If we fail to provide our 15-19% of the overall budget, Remedy Missions fail, surgeons and nurses do not get trained regularly, on-site audits from our international team do not happen, up to 20 children are delayed from receiving surgery, and a few may even die or become inoperable. Your role in funding the remaining 15-19% is as critical in the short term as any other entity. A single Remedy Mission is binary - it either happens or it doesn't. Your money makes it happen. But our goal is to continue to graduate all our programs so they are 100% funded locally in the next 5-10 years. [Back to Top]

 Q: Any other costs?

A: Our numbers per Remedy Mission do not account for "indirect costs," such as the cost (or value) of our volunteer medical staff from around the world, costs to local healthcare systems, the cost of a family to travel to the surgery site, the opportunity costs of lost income for families as they wait for surgery, etc. The reason we think it's important to note this here is because lifesaving is actually quite difficult. Building a pediatric cardiac surgery system for the entire country of Iraq is laborious and full of complexities. [Back to Top]

 Q: What is the bottleneck to more surgeries: money or skilled labor?

A: People often assume that the biggest need is more Iraqi heart surgeons. We could use a few more, but the real bottleneck is skilled nurses, technicians, and non-surgical physicians. A surgeon is only as good as his support staff. One of our biggest challenges is training pediatric cardiac intensive care nurses. To date, we haven't found a better model than our Remedy Missions through which we bring quarterly hands-on training to local nurses (and surgeons) in Iraq. Rather than exporting the nurses to Europe or the USA for training (whose medical systems barely resemble the Iraqi system), we train them with what they have on hand in their local environment. [Back to Top]

 Q: I'm skeptical of non-profits and charities because they always seem to be asking for more money. How can I be sure that Preemptive Love Coalition has "room for more funding" and that I'm not paying into a huge savings account, "Rainy Day Fund", or something similar?

A: For the record, we are skeptical of non-profits as well! In 2012 PLC needs $350,000 on hand at any given time to cover our cash flow needs for up to three Remedy Missions per quarter. We are still 30% under-funded against that goal. In addition to cash flow needs, we still require 15-19% funding on most of our missions after local sources contribute their portion; we have un-funded pilot programs in new cities where local doctors have been requesting our help (but where weve yet to woo local philanthropists or health directors); and we have research and social service initiatives through our Followthrough program that require funding at present because we have not yet sought local funding for those initiatives (seeing as how they relate mostly to our Monitoring & Impact Evaluation objectives). Please see our "Funding Gap" page to look deeper into our anticipated program costs, the sources of funding we are counting on, and the funding gap between the two for the next few years. [Back to Top]

 Q: Do you have enough volunteer surgeons available for unfunded Remedy Missions? (i.e., are there trips that you could fund if you had more money, or is there a labor bottleneck?)

A: Great question! We use a hybrid volunteer/staff model. Roughly 25-30% of any one of our Remedy Mission teams is employed by the International Children's Heart Foundation (typically the surgeon, scrub nurse, anesthesiologist, ICU doctor, and often a part-time ICU nurse). The remainder of the team typically comprises volunteer physicians, technicians, and nurses from across the world. Because the hardest-to-come-by positions are contract labor for us and NOT volunteers, we have never failed to run a mission for lack of personnel. We have only cancelled or turned down a request for a future mission due to lack of funding. [Back to Top]

 Q: Many heart surgeries require follow-up treatment (including additional surgeries). Do you have a way of providing these to patients?

A: Yes, we do. Our model dictates quarterly visits to each program site (a hospital inside a regional hub). Our reliance on local cardiologists ensures that the local team prioritizes and almost entirely sets the agenda for patient selection (within a development curricula) - after all, Iraqi doctors are the ones who are most intimately connected to the patients and their daily progress! When a local cardiologist sees a child who has either (1) deteriorated and requires another intervention or (2) advanced as expected to the next step of a complex, staged intervention, the child is prioritized for follow-up treatment. [Back to Top]

 Q: How do you assess whether surgeries are completed competently and appropriately?

A: Because we are a broker and play a combination administrative and financier role in the coalition of partners working in Iraq to develop pediatric cardiac care, we are able to stand in-between the local surgical team and the international surgical team (whom we contract as a third-party to train and perform surgeries in Iraq). If the local team or health directorate suspects a lack of competence in the international team, a cavalier attitude, or a single poor judgement call, our role is to be the go-between - to be the advocate for the local healthcare providers vis-a-vis the international surgical team.

Similarly, if the international surgical team feels pushed by the local surgical team to perform procedures with which they are uncomfortable or for which they think the local system is ill-prepared, they are able to refuse children for surgery and/or use us (PLC) as a go-between.

The checks-and-balance between the two teams helps us ensure surgeries are performed in a competent, appropriate manner. [Back to Top]

 Q: What is the rate of complications during and following surgery?

A: We report our in-hospital and 60-day mortality after each Remedy Mission. You can finds those numbers here. We also produce reports after each Remedy Mission detailing the trip, including data on intraoperative complications, post-operative complications, and mortality. You can find those reports here. We are also deliberately raising the funds necessary to help us bring our various heart hospitals into compliance with the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing Countries. If this kind of quality improvement and reporting initiative interests you, we are currently looking for financial partners for our Followthrough program. [Back to Top]

 Q: How do you assess whether surgeons are performing additional surgeries that they would have not had the funding or motivation to perform otherwise?

A: Pediatric heart surgery in Iraq is almost nonexistent without our work. There are two active programs for relatively simple surgeries (one in Erbil and one in Baghdad). Local surgeons claim that combined they perform no more than a few hundred pediatric surgeries a year. In every location where we work, pediatric heart surgery is effectively nonexistent. Therefore, every surgery performed at our program sites (both when we are present and when we are not) are "additional surgeries" that they would not have had the SKILL to perform without the FUNDING we employed to train them in their local environment. [Back to Top]

 Q: How do you assess whether surgeons are charging their patients for the surgeries you fund?

A: Because we work in public (government) hospitals - and because healthcare in Iraq is provided almost entirely free of charge - it is widely known that any cardiologist, surgeon, or administrator seeking compensation for services is acting outside of Iraqi law. [Back to Top]

 Q: Do you follow up with the surgeons you've trained to assess whether they are correctly applying their training?

A: We see them quarterly in their local environment and perform real-time audits of their skills, recollection of past training, application of new techniques, etc. Additionally, our international surgeon remains on call at any time via phone, Skype, or email for consultation. [Back to Top]

 Q: What information is available on the activities - and competence - of the surgeons you've trained?

A: Because our Remedy Mission training program only began in late 2010 - and pediatric heart surgery at our sites across Iraq is the same age - there is still relatively little independent practice to report, and therefore little data on the activities and competence of our surgeons and their teams. But as they begin performing more surgeries independently, we are trying to align each site/surgical team with the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing Countries (a data collection and tracking initiative of Children's Hospital Boston and Harvard University). [Back to Top]

 Q: Where do surgeons work after completing training? Do they serve poor patients?

A: As of Q2 2011 there was only one private hospital in Iraq (to our knowledge) providing pediatric heart surgery (and those surgeries were on the lower end of the complexity scale). Our work does not necessarily mean to exclude private hospitals as they continue to come online and become viable options, but at present the government system has a better equipped foundation for training local surgical teams. As we look to fully graduate our local surgical teams in the next 5-10 years, we imagine that most of them will stay in the public sector for all of the stability, pensions, and benefits of loyalty provided to those who stick with it. But, undoubtedly, some will seek positions at private hospitals (assuming private hospitals are willing to invest in the requisite capital purchases necessary to establish a credible program). In the public sector, rich and poor are served alike. In the private sector, poorer patients would be at an obvious disadvantage. [Back to Top]

 Q: How much do you spend each year on "program" expenses and how much on "overhead?"

A: As a rule, we do not adhere to the model that claims that "overhead" is somehow bad and "program" is somehow good. There are very bad program expenses. There are overhead expenses that are excellent investments. We agree with Paul Brest, President of the Hewlett Foundation, when he said, "Achieving a low overhead ratio drives many charities to behaviors that make them less effective and means more, not less, wasted dollars." Therefore, we spend as much on overhead as we need to accomplish our mission. The mission itself is our North Star - not arbitrary (even harmful) standards about overhead-vs-program expenditures. For the record, however, you can find a current pie chart of our expenditures here (and if you're into that sort of thing, you'll probably be impressed!). [Back to Top]

Jeremy Courtney Founder, Executive Director Twitter: @Jeremy_Courtney

“I'd love to hear any critique or questions you might have!”

DROP A NOTE OR DONATION BY MAIL: Preemptive Love Coalition 1300 Darbyton Dr. Hewitt, TX 76643 GIVE BY PHONE: To make a gift over the phone, using your credit card (Visa, MasterCard, American Express, or Discover), please call +1 (806) 853-9131 during normal business hours. IRAQ OFFICE: +964 770-355-6298 (local)

OUR CORE VALUES: Multi-Dimensional Reconciliation

February 8, 2010 by Jeremy · Leave a Comment 

Photo: Matt Addington

Call it settling accounts, setting to rights, or the restoration of friendly relations – reconciliation is why we do what we do.

There are thousands of children in Iraq who are born with hearts “at odds” with the good intentions of GOD when He created the world. We want to set that physical situation to rights; to reconcile what is with what should be.

But a healed heart is an occasion for only a tempered celebration if your family is living in the middle of civil conflict between ethnic neighbors or regional superpowers. Sure, much of this strife comes from global issues that are beyond our direct reach. But a few days on the ground in Arab Iraq, Kurdish Iraq, Turkey, etc makes it clear that these “global issues” are exacerbated by our closely held opinions about “the other.”

Photo: Matt Addington

So we work to unravel the effects of evil that were wrought by Saddam Hussein’s genocidal campaigns, by years of sectarian conflict between Sunni and Shi’i Muslims, and by ethnic struggles.

For example, Kurds, Arabs, and Turkmen are in a political (and possibly cultural) struggle over the historic city of Kirkuk – each laying some sort of ancient claim to the city; each group (generally) vilifying the other. On his Restorative Justice blog, Dr. Howard Zehr talks about our “temptation to emphasize ‘otherness’,” whether it be through photography, storytelling, or our administration of justice. At the Preemptive Love Coalition, we do not deny “otherness” when working between ethnic and tribal prejudices or religious worldview differences. But we try not to make “otherness” our starting point.

Communication guru Joseph Grenny talks about the important role that “storytelling” plays in our emotions and actions. According to Grenny, (1) we make an observation (e.g., Saddam Hussein was an Arab with largely Arab soldiers that attacked our city) and (2) immediately start telling ourselves a story (e.g., therefore all Arabs in Iraq want “our” land and are evil and would kill us if they had the chance) which (3) leads to strong emotions (like fear and hate), thereby (4) triggering fight/flight instincts inside us such as protectionist policies or aggressive police (or vigilante) action. The fork in the road is that first story we tell ourselves when faced with an observable fact.

You can see how this plays out closer to home, as well. Observable fact: Men who wrapped themselves in Islam attacked America on September 11, 2001. But the stories that have flowed from that fact have been varied. And the emotions that arise from those stories have been serious and sincere. And over the past decade the actions that have come out of those various emotions have changed the course of world politics, international relations, and daily life for millions.

So when you donate, host an event, or buy a tshirt or pair of shoes, you are engaged in something bigger than the shuffling of money from one place to another to save a child’s life. We give people over “here” a tangible opportunity to save a life over “there” and to see “those” people as exactly that: people. Humans. Sons and daughters. We are all more than the images we receive from the professional media. It’s not “us” helping “them” get over “their” problems. It’s “us” becoming reconciled with “us”.

And in case you are wondering… Yes, we are just naive enough to believe that when we start seeing each less as other and more as brother these “global issues” might start to change too. And if they don’t… well, we are still committed to making change in the neighborhoods where we live and work; to be people of peace – whether anyone joins us on the journey or not.

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 Interactive Graphic Overview of What We’ve Been Up to for the Last Few Years

August 23, 2009 by Jeremy · 486 Comments 

Drag and drop and click and scroll and comment and push and play your way through some of our [online] activity from the last year.

Special Features of Note:

Be sure to Click on Map>Play Events for a Worldwide Conversation of Sorts Between Our Offices Around the World

View fullscreen below for more room to play around!

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.

Report on “Iraq: The Forgotten Story” Art Show in UK & Beyond (VIDEO)

June 18, 2009 by Jeremy · 672 Comments 

On May 22, 2009, the Preemptive Love Coalition unveiled IRAQ – THE FORGOTTEN STORY at our inaugural event outside London, England. The Forgotten Story features the work of 6 Iraqi artists and tells the story of life in Iraq under Saddam Hussein’s Ba’ath Regime through their eyes.

The above video was compiled by a Kurdish company out of London that attended the event.

All proceeds from events, donations, and sales of this art help the Preemptive Love Coalition give life-saving heart surgeries to Iraqi children and create cooperation between communities at odds.

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.

Iraq: The Forgotten Story Unveiled in England

May 23, 2009 by Jeremy · Comments Off 

Shortly after we began our work in 2007, under the direction of PLC co-founder Cody Fisher, the Preemptive Love Coalition set out to use original Iraqi art as a means of fulfilling our three-fold mission of (1) funding life-saving heart surgeries for Iraqi kids; (2) increasing cooperation between communities at odds; (3) and investing foreign revenue into local Iraqi economies.

On May 22, 2009, the Preemptive Love Coalition unveiled IRAQ – THE FORGOTTEN STORY at our inaugural event outside London, England. The Forgotten Story features the work of 6 Iraqi artists and tells the story of life in Iraq under Saddam Hussein’s Ba’ath Regime through their eyes.

But this is not a backward looking collection. The purpose of pulling together these stories and touring them around the world is to look forward together, for the future of Iraq.

For more information on the current event in Luton, England and for inquiries about future events, please visit our partners, A Thin Place, at www.AThinPlace.org.

SAMPLES OF FINE & PHOTOGRAPHIC ART

PHOTOS FROM THE OPENING EVENT

PARTNERS & SPONSORS

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.

Filed under: A Thin Place, Amazed, Art, Go Blog It!, Photography

“Iraq – A New Face” at the Green House Gallery

April 16, 2009 by Jeremy · 341 Comments 

Some of our good friends, Ian (of Wales) and Ben (of England), are helping PLC to launch our global tour of the works of ten Iraqi artists (painters and photographers).  They came to visit in February to help make sure that all of the art would be selected and handled professionally.

The Luton Duo shot quite a bit of their own arresting photography while they were here and they’ve currently got it on exhibit as “Iraq – A New Face” at Luton’s Green House Gallery through May 17th.

For more information on this installation, grab this flyer or visit A Thin Place international artists collective.

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.

Filed under: A Thin Place, Art, Photography

Preemptive Love Art Exhibition.

May 8, 2008 by Cody · Leave a Comment 

If there’s one thing I’ve learned out here, it’s this: Always love. It doesn’t matter what it looks like or how it appears to those around you…just love. Maybe that’s because I’ve been exposed to so much hate here and I’ve grown to learn where that leads us as people. I say “us” because it’s in all of us. It’s not confined to Baghdad or terrorists or anybody else we label as a “bad guy.” We’re all affected by it. Another thing we have in common is the ability to love. Love isn’t contained in a building or in the “good guys” either. If you’re breathing…you can love.

Artists here in Northern Iraq recently pulled together to do exactly that. On top of all being able to breath, they are all extremely talented at creating art. Over thirty artists created and donated art to be displayed in Zamwa Gallery to show their support and advocacy on behalf of the children of Kurdistan. Instead of just being hung on a wall, their art is driving out complacency and hate and ushering in love.

When I first arrived here there were around 700 registered children with heart disease. Being registered isn’t a bad thing unless you’re lost in a list of 700 names waiting your turn to be send abroad for urgent surgery. Waiting in line isn’t a bad thing unless your heart needs to be treated immediately in order to survive. Just a few weeks ago we found out that the list of 700 kids has grown to a list of over 2,800.

If I’m completely honest then I’ll tell you that this is way too big for me. It’s way to big for you. It’s too big for an artist and even a doctor. But…if we’re still being honest, then I’ll tell you that all of us together CAN create change. We CAN help raise awareness. We CAN be a voice for these children. We CAN love. By “we” I mean painters, bloggers, doctors, writers, singers, students, business men, street sweepers, and anybody else that can breath.

So love. It may manifest itself in a piece of art, be shouted from a soap box or go completely unnoticed. It’s up to you. Just love.

All of the art from the gallery along with some of Buy Shoes. Save Lives.’ photography has been compiled into a book that can be purchased on our on-line store. Get one before they run out! All of the proceeds go to help fund heart surgeries. It’s simple.

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.

Filed under: Amazed, Art, Coverage, Go Blog It!, Heart Surgery, News, Our Kids

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