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)

Raise Your Tea Glasses High And Drink To Saving Lives!

October 18, 2012 by Cody · Leave a Comment 

Kurdish Mountain Chai is a locally owned and operated business based out of Louisville, Kentucky.

Their commitment? To brew the best cup of tea you’ve ever had and to save lives while doing it.

For every pack of tea Kurdish Mountain Chai sells, a dollar goes toward another lifesaving heart surgery in Iraq.

Now, who wouldn’t toast to that?

We at the Preemptive Love Coalition are partial towards charitable businesses. After all, it’s how we first started saving lives with Buy Shoes. Save Lives. back in 2007.

A pair of handmade shoes. A glass of well-brewed tea. Another business that cares. These are some of the reasons we’re able to save another life this month.

Have a charitable business idea of your own? Write us at info[@]preemptivelove.org and let us know how we can partner with you!

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.

Ramadan—The Spirit of Giving

July 25, 2012 by Monique · Leave a Comment 

The month of Ramadan is an important time in the Muslim world with its emphasis on communing with God through fasting, praying, and giving to the poor. As a group based in Iraq, most of the people we interact with
here—friends, neighbors, coworkers, surgery kids, etc.—are Muslim, and most of them observe and celebrate Ramadan.

With that many people caring about it around us, it’s no surprise that we have grown to care about the month as well. We see it as an opportunity to reestablish what we have in common: a love for God and a desire to care for needy children and their families. This video offers a unique glimpse into our community here and why we want to partner with you this Ramadan in saving children’s lives.

To join us in caring for these children, please consider helping us save a life this Ramadan by funding medical supplies below!

Donate a surgical supply kit to save a child’s life this Ramadan.

Hailing from Hong Kong, Monique's background in film and communication make her the perfect choice for our Video Intern position. She is spending her summer documenting life in Iraq through writing and videography, helping with office administration, and—inshallah—teaching the entire PLC staff how to make delicious Chinese dumplings!

Counting Kids: Researching Heart Defects in Dohuk

June 12, 2012 by Alicia · Leave a Comment 

Right off the bat, I got to be a part of something awesome here in Iraq.

I joined PLC’s groundbreaking research in the city of Dohuk in Iraqi Kurdistan. Many reports in recent years claim that there are more heart defects in Iraq than other countries in the Middle East. In Fallujah, news reports state 10 times more birth defects than the world average. However, these numbers are based on general observations, not a systematic study. Is it possible that doctors who only see sick children would think there are many more birth defects than there really are?

The best way to find out if there are more kids being born with broken hearts is to count all the children who are born, then see how many have heart defects are detected. That way, the number of healthy babies can be compared to the number of babies with defects to get an accurate ratio of sick to healthy babies. This is exactly what we did in the city of Dohuk.

Alongside long-time friend and partner of PLC, Dr. Kirk Milhoan and Dr. Serdar Pedawi, I was a part of a research team working to identify the heart defect “incidence” or number of new cases of babies born with heart defects out of all babies born over a certain time period. We set up camp at Azadi Teaching Hospital in Dohuk, and every child that was born came to us to be screened for heart defects.

This was done using an echocardiogram (ECHO) machine, which is similar to an ultrasound that allows pregnant mothers to see their babies. It provides a way to look at the heart from the outside, quickly and painlessly. All children born in Azadi Hospital during the week of the study had to be screened in order to obtain their birth certificate, so we were able to screen more than 180 kids!

Each individual encounter was very similar. The moms were usually too worn out from childbirth to bring the babies to us (understandably so!). It fell to the grandmothers and aunts to take care of the newborn while mom got some rest. It was beautiful to see how much love and care was shown to each baby we screened. They were all wrapped tightly in brightly colored clothes and tucked into what I can only describe as a fancy baby sleeping bag.

The children truly lived up to the phrase of “bundles of joy.” The pride and joy of family members was evident, but with it came the anxious fear that their baby could have something wrong with their heart. Immediately at the time of the screening we could tell the family the result of the ECHO.

Thankfully, the vast majority of children had completely normal hearts and their family was always relieved and ecstatic to hear the good news. But there were some babies who did indeed have heart defects. Some had leaky heart valves and others had holes in their heart. Assurance was given to the families that these were not immediately life-threatening emergencies, but that their baby needed to be checked again in a few weeks to see what kind of treatment would be needed to live a normal healthy life.

Dr. Serdar works full time as a Pediatric Cardiologist in Dohuk, and thus will take care of these babies directly. Research can sometimes be all about collecting numbers, but this research heavily emphasized providing practical medical care for those who were found to have heart defects.

It was an absolutely incredible experience to interact with the Kurdish and Arab families in Dohuk as well as to be a part of a first-ever scientific study. It was very fulfilling to contribute to the gathering of facts, which is a large part of why I’m pursuing a Master’s in Public Health. Having solid facts puts Preemptive Love Coalition that much closer to eradicating the backlog by treating kids who need lifesaving heart surgeries.

This research is the first step in providing information for the Kurdish Regional and Iraqi Central Government and any other organization that wants an answer to the question: how many Iraqi children are being born with heart defects?

Alicia Lay is a Texan, foodie, and atypical medical student who is interning as a medical researcher as she works towards her Master’s in Public Health. She is passionate about international medicine, surgery, public health, and Iraqi children. When not in a hospital or doing research on the computer, she enjoys taking photos, reading about global health, and singing the day away as if her life were a musical.

Old Welcomes New—Meet the Amazing Grandmothers of Northern Iraq (Kurdistan)!

May 29, 2012 by Kendelyn · Leave a Comment 

Grandmothers; they’ll pinch you, they’ll squeeze you, and they’ll always hold you tight.

Our recent screening mission in Dohuk saw a constant stream of grandmothers caring for their newborn grandchild as the weary mothers rested. And for that, I salute them. They are truly fantastic women!

A Kurdish grandmother poses with her grandchild after learning the child was free of any heart defects.

A Kurdish Yazidi grandmother rewraps her grandchild after the child’s screening—no heart defect found!

These grandmothers were incredible at caring for the newborns. This one kept her grandchild distracted during the screening.

Kendelyn is a 2012 summer intern who LOVES taking photos, and you can find her strolling the streets snapping shots of anything from flowers to friends to googly-eyed stuffed goats. She's excited to be working in Iraq this summer as PLC's photography intern and looks forward to learning more about its culture and people.

“A Girl Called Iba”—A Documentary About Honor & Shame

April 26, 2012 by matt · Comments Off 

Former short-term staff member Lydia O’Neil just released her documentary from her time in Kurdistan! In it, she takes a behind-the-scenes look at what Kurdish girls really think about boys, family-expectations, and shame. Check it out!

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

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OUR BLOGGERS

	Matt Willingham is the PLC press secretary and writes primarily on politics, history, general updates and visual peacemaking through photography and film.
	Cody Fisher is a PLC cofounder and writes primarily on program development and peacemaking by giving us a lens into the lives of the real people we love.
	Jeremy Courtney is a PLC cofounder and writes primarily to emphasize our vision and values, including organizational and financial transparency.

Preemptive Love Coalition provides lifesaving heart surgeries for Iraqi children in pursuit of peace between communities at odds. We offer the untold thousands of Iraqi kids suffering from life-threatening heart defects a chance at the surgery they need to save their lives. With our world-class international surgical partners, we create long-term solutions by training local Iraqi doctors and nurses so they can sustainably save lives without our help.

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