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)

Family Advocate Connecting with a Two-year-old Waiting for Heart Surgery

July 11, 2010 by Sophia · Leave a Comment 

On a house visit last week I noticed Chro’s tiny bright-pink fingernails and toenails as she sat squeamishly on her father’s lap. Chro is one of five children going to surgery on July 18.

Her father is a policeman, a civil servant in charge of protecting their village; but right now he is focused on protecting his little girl by sending her to surgery. At 2 years old, Chro is battling the heart disease inside her chest.

As I sat with her family on the knit rugs that lined their living room floor, Chro’s eyes anxiously looked around. She started to whimper a faint cry because her lungs can hardly provide enough oxygen for the deep breaths that are required to shed many tears.

She was scared.

I could only imagine what might be going through Chro’s head. She is a little girl, who will soon be getting on a plane and flying to a foreign country only to have her small heart cut open and restored. Can she possibly grasp the magnitude of lifesaving heart surgery? I cannot possibly understand what it feels like to be a scared two-year-old with shortness of breath and probing doctors.

After I asked Chro’s family about her likes, her mother, a sturdy Kurdish woman with a protruding pregnant belly, smiled and said, “Dolls, lollipops and ice cream.”

I realized that Chro is a normal little girl. In spite of facing a disease that threatens to take her life, she is a little girl who likes lollipops, rainbows, baby dolls and bright pink. I think we have more in common than I first thought.

Sophia Pappas, a PLC summer intern ('10), is passionate about living, loving and saving lives. While in Iraq, Sophie enjoys wandering the bazaar, trying local foods and playing with the kids.

Soccer balls and Staircases Reflecting a Renewed Childhood

July 1, 2010 by Alex · Leave a Comment 

When I visted Ahmad earlier this week, I was struck by two objects that embodied the effect PLC has had on the life of a child who has undergone heart surgery.

The first was the metal staircase leading up to their home on the second level of the block. This old staircase was red, rickety, and full of holes — a lot like Ahmad’s heart was a year and a half ago. Ahmad had one of the most complex cases of heart disease PLC has seen. His combination of defects turned his lips, hands and feet blue from lack of oxygen and assured that he would not have a normal or lasting childhood. But thanks to your support, commitment from his family and the skill of medical professionals in Iraq and Turkey, Ahmad could greet us at the top of the stairs with a smile on his face.

Ahmad’s medical story is not finished. He still has some blue to his lips and will need more surgeries down the line; but a second powerful image — that of a tattered and beaten up soccer ball — made me realize how much of an impact his first surgery truly had.

Worn out soccer balls are certainly not uncommon in Iraq, and I probably wouldn’t have given Ahmad’s ball a second thought if his mother had not pointed out that this was the same ball that was given to him by PLC just a year ago. Ahmad, a boy who had not been able to run last year because of fatigue from a lack of oxygen, had beaten his new soccer ball to shreds playing with friends.

This is the impact Ahmad’s surgery has had. He may not have a totally corrected heart yet, but he does have a childhood — full of running, playing, laughing, falling, scraping knees and wearing out soccer balls.

Alex Phillips, a two-time PLC summer intern ('10 & '11), has invested his heart into the surgical and medicinal aid available to the children of Iraq, hoping to better understand the complicated ties between poverty and health. On his off days, Alex spends his time reading up on his field, listening to punk rock, riding his bike, and updating his Twitter: @_alexphillips.

Backed Into a Corner: Doctors Adapting to Hardships in Iraq

June 30, 2010 by Preston · Leave a Comment 

As a doctor, decisions that affect a person’s quality of life come with the job, and this is no different for our local cardiologist, Dr. Aso Faeq. While shadowing Dr. Aso in his office earlier this week, I witnessed how the problems in Iraq make these decisions even more difficult.

As I saw patient after patient visit Dr. Aso’s office last Wednesday, the fact that congenital heart disease is a rampant problem here in northern Iraq became blatantly obvious. Families drove for hours just to see this one cardiologist examine their child, and so many of them were told about the urgency of their child’s heart condition.

Though so many cases are urgent, Dr. Aso is restricted from the limited options he has available to him in Iraq. The lack of training and technology for doctors along with poverty and cultural dilemmas prevent many children from receiving surgery in the country. It’s hardships like these that affect Dr. Aso’s decision making every day.

One of his decisions that resonated with me concerned the fate of a three-month-old boy. His parents brought him to the office knowing he had a heart problem, but they needed Dr. Aso to examine and diagnose him. After a few seconds of doing the echocardiogram (an ultrasound of the heart), Dr. Aso’s whole demeanor changed instantly.

He explained to us that two of the little boy’s heart chambers were malformed and merged into a single chamber causing immense pressure to build in his heart. As the family and Dr. Aso discussed their options, the limitations became obvious. The surgery the child needs could be done in a town six hours away, but the family did not have the money to do this. On top of this, the next group of American non-profit surgeons who will perform local surgeries here does not arrive for another fifty days, which could be too late for the dying boy.

For a solid 10 minutes Dr. Aso did not say a word. He sat there, weighing the child’s options and deciding his fate. Imagine the immensity of this decision. Dr. Aso has basically been backed into a corner and told to make a decision on this child’s life. And so, he did. Waiting is the only option. He spoke to the parents, comforted them, signed the papers, and watched as the next patient walked in.

Dr. Aso often finds himself faced with difficult decisions, but with the options available to him he takes the initiative to make the best call for these children. These families are, in fact, some of the strongest people I have ever witnessed. They face impending tragedy while dealing with poverty and neglect. Sitting in Dr. Aso’s office, however, allowed me to see that real initiative can cause real change in the face of immense hardship.

People like Dr. Aso take this initiative as far as they can, and PLC hopes to offer opportunities for this initiative to be extended across the world. Whether it be through buying Klash from our Buy Shoes. Save Lives. program, supporting local healthcare through Remedy Mission, or creatively partnering with PLC to find new ways of providing these heart surgeries, you can also take the initiative to make a difference in childrens’ lives.

Preston Wright, a PLC summer intern ('10), has dedicated his summer to spending time working with the Iraqi people, specifically, visiting with Kurdish children, Klash makers and doctors. When he is not preoccupied with his intern duties the West Tennesseean enjoys playing soccer and working with children.

Celebrating Fathers (Day)

June 20, 2010 by Esther · Leave a Comment 

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

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

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

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

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

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

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

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

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

UPDATE on Three PLC Kids Three Months After Surgery

June 20, 2010 by Sophia · Leave a Comment 

Driving the dusty highways of Iraq, past kids selling water on the side of the road and through security checkpoints, I’ve found that the journey to visit PLC patients is one of joy. These family visits after a child has been sent to surgery are used to see the child’s progress and their health condition post-surgery.

Last week I had the pleasure of visiting three children who have already undergone surgery. Mohammed, Deelan, and Sara received successful, life-saving heart surgeries earlier this year, and what a joy it was to see them doing well only a few months after!

Eleven-month-old Mohammed entered the reunion screaming his head off – a wonderful sign of healthy lungs and a healthy heart! Mohammed has been gaining weight since his return home and can happily entertain himself with a cell phone on his father’s lap, not unlike many babies his age.

Deelan, now one and a half years old, has had tremendous improvement in his condition. Before surgery Deelan was a very weak and frail little boy, but he is now feisty and pushing over tables and chairs!

As Jessica, the family services director for PLC, recalled, “Deelan was so weak and tired on the way to surgery… his mother just didn’t know what to do with him.” That doesn’t seem to be a problem for Deelan’s mother now since it appears she spends some of her time chasing Deelan as his tiny legs run in circles around the room.

Sara, who is 14 years old, had her surgery in March. Ever so polite, she carries herself with confidence and maturity. When asked what she hopes to be in the future, Sara said proudly that she wants to study medicine, because her doctors were, in her own words, “so good.”

Revisiting kids like these three that inspires us at PLC to continue our work here in Iraq. Some days the stories of sick children are hard to handle, but when we are able to see tired and defeated faces turn into healthy and smiling ones, it certainly gives us strength.

Sophia Pappas, a PLC summer intern ('10), is passionate about living, loving and saving lives. While in Iraq, Sophie enjoys wandering the bazaar, trying local foods and playing with the kids.

A Visit with Mohammad Made Reality Sink in for a PLC Intern

June 9, 2010 by Lydia · Leave a Comment 

Meet Mohammad, 2 years old and dying from heart disease.

Monday, some of the PLC interns and I went to talk with Mohammad’s parents about his health and their finances. Because of miscommunications, they’ve lost the $6,000 loan they thought they had secured for his surgery. They are now facing the reality that they can’t afford the surgery necessary to save their son’s life.

I’m not sure if I’ve ever been in a room with someone who was literally dying. I never expected the first time to be a 2-year-old Iraqi boy.

The Iraqis in this area are huge on hospitality. Before we left, the family gave us plates of grapes and cucumbers. It was humbling to receive so much from people who have so little.

Its hard to know how to respond to little Mohammad, who weighs less than 20 pounds and has not gained weight in over a year. In my own life I would dismiss it by saying “Don’t worry about it, I’m sure it’ll all work out.” and rely on my insurance company, parent’s wallet, extended family’s gifts, and a strong network of prayer. So, I am inclined to think that any situation, no matter how destitute, will eventually be made right.

It’s hard to fully grasp that for Mohammad and his parents that is not necessarily the case. Right now, they’re relying heavily on PLC to take their son to surgery, to save his life. But even that might not be enough. His medicine has become more complicated, mostly because he refuses to take it (I guess 2-year-olds are the same everywhere), and their money has nearly run out. This family has no “fallback plan”, no money set aside for emergencies.

So pray for Mohammad. Pray for his parents and their financial capability. Because I know a lot of 2-year-olds, but now I know one more. And so do you.

Donate the amount of your choice by entering it in the field below. All donations will help send Mohammad (and any others in his group) to life-saving heart surgery. Donation:

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.

Visiting Honya Sparked Memories and Joy in Preemptive Love Staff

June 8, 2010 by Joshua · Leave a Comment 

Since the first day I met this girl – that first day when her parents took her from the hospital and brought her to our office with her bloody I.V. still in hand – she has been a favorite of mine. Alright, I know I’m probably not supposed to have favorites in this work, but I do. And Honya is one of them. I’ll never forget that first time we met last September.

I so clearly remember my thoughts – how afraid her parents seemed; how this tiny bundle in a mother’s arms seemed too delicate to be human; how the faded blood on her bandages seemed to match her shirt perfectly; how I thought this girl would never be sent to surgery, given her fragility.

Well, I was wrong. And in being so proven, I have grown irreversibly attached to her.

Honya was the first child I traveled with to surgery. In the Iraqi airport as her father waved goodbye, watching his wife and only daughter leave the country for the first time, I saw a foreshadowing of the emotional days ahead. The fears, the tension, the waiting, the unknowns – it was impossible to go through these things with them and not be drawn close to her and her family.

Honya won my heart. This tiny girl with a body in need of repair – this innocent, beautiful young child – had captured me. Praise God the surgery was successful and that Honya has had her life restored to her, perhaps relieving my heart as much as her parents’. She has been home now for seven months and is doing great! We recently heard she was sick and was taken to our local hospital. So, I went with Awara and Jessica to visit her and her family to make sure she was doing well.

What can I possibly write that is not better expressed through photographs?

Could I express her smile in words, or just show you? Could I write of her growth, of her energy, and her pinkness; or just show photographs? Could I write of the transformation of this little girl from a tiny baby in the arms of a fearful mother, or just show you her smile as she runs down the halls? Could I write of how her little eyes melt my heart, or just let you see them?

Joshua Gigliotti is a PLC Summer Intern ('09) turned short-term staff who spends a majority of his time with PLC taking exceptional photos of children in Iraq in an effort to humanize Iraqis and portray them as people full of dreams and hope. When his camera is not in-hand, Josh is often found in local tea houses with friends and also enjoys traversing the great outdoors. Follow Joshua on Twitter: @JoshGigs.

Yahya’s Playtime with a Preemptive Love Family Advocate

June 5, 2010 by Sophia · 1 Comment 

The first time I wandered onto the Preemptive Love Coalition website, I was drawn to the images. The poignant photos of sick children laughing and playing made their personalities come to life. Delicately illustrated stories depicted the reality of their conditions and the urgency to help them. Already a very maternal person, I instantly wanted to pick them up, talk to them, play with them, comfort them, and ultimately help save their lives. Before this summer, I could only imagine how beautiful an encounter with one of these children would be.

Just the other day, I experienced the first of what I hope to be many encounters with PLC kids. Shy and nestled under the skirt of his mother’s headscarf, five year-old Yahya came into the PLC office. His sweet smile was masked by a veil of bashfulness and uncertainty, and I was eager to make him giggle. Bouncing balls, coloring pictures and shooting a rubber band gun helped me break the ice. I was essentially making myself look like a fool in order to get him to laugh, but it was all worth it to see the look on his face when he realized that he could relax; that he could play.

I didn’t speak the unique Kurdish-Arabic blend of his family when I played with Yahya, but I didn’t need to in order to communicate with him. Sharing the qualities of just about every child I have ever met, Yahya wanted nothing more than to feel comfortable and at ease so that he could goof around and enjoy himself. It takes few language skills to have playtime with a preschooler.

At five years old, Yahya’s short life has been filled with little playtime. Born with some of the most complex heart problems, Yahya’s grave condition set him on a path filled with physical malformations and potential social setbacks. But while we were playing, he was just a normal little boy waiting for a lifesaving surgery.

I can honestly say that my short time with Yahya is one of the most rewarding things I have done since coming to Iraq. Yahya is a very ill little boy, and I know that my loving him cannot save him. But playtime can do wonderful things for a child!

Our goal for Yahya today is to raise an additional $1,500 for airfare, food, housing, translation services, remaining surgery expenses and additional contingencies. Whether you’ve seen Yahya around before or this is your first time, help us go beyond meaningful play times to get Yahya the surgical therapy through which he will benefit so much.

Sophia Pappas, a PLC summer intern ('10), is passionate about living, loving and saving lives. While in Iraq, Sophie enjoys wandering the bazaar, trying local foods and playing with the kids.

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

June 2, 2010 by Esther · Leave a Comment 

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

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

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

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

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

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

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

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

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

Nivar Plays Soccer in Iraq and is Reminded Daily of Her Need for Surgery

May 29, 2010 by Joshua · 1 Comment 

From the day I first met her in our office, what I remember most are her eyes. In the land of dark skin and eyes to match, Nivar and her hopeful, green eyes separate themselves from the rest.

Nivar is a young girl who feels the effects of her heart defects, a girl who is reminded daily of her need for surgery. Unlike some of our kids, who can live lives without many outward signs of their inward battle, the results of her defect is evident.

I went with Awara to visit Nivar and her family in the volatile Iraqi city of Chamchamal and was again reminded how I hate seeing the innocent suffer.  While Awara stayed inside to talk with her family, I was outside with Nivar and her brother, playing with their futbol, as has become the norm.

We started to kick it around, allowing the futbol to distract us from the pain of this situation. We forgot about thoughts of her failing heart; that she was different from me and her brother. We forgot this until Nivar walked away from us and lied down on their swing.

At first, I wasn’t sure what to make of this. Did she just not like futbol? Did she not like me?! What was it? I asked her to come back and play with us, and she quietly replied, “Natwanim, helakim” (I can’t. I’m tired).

Then it hit me. She really couldn’t keep playing. Her heart couldn’t handle it. She had no choice but to sit and rest.

And this is when I again started to grieve. What did Nivar do wrong? I long for restoration, when bodies no longer fail; when children no longer fear their hearts; when all is made right. I look into Nivar’s strikingly green, innocent eyes and need someone to blame.

This isn’t fair; it isn’t right. I am weary of child after child being brought to us by hopeful parents, praying to God we can save their son or daughter. Today, I just need someone to blame.

Is this Saddam’s fault, like so many claim? The chemical attacks, the gassing of thousands, the testing of primitive nerve gas agents on abducted Kurds − is this all his fault?

Those bombs he dropped; those slow-falling bombs filled with chemicals designed to savagely destroy all things living − what about those? Can I blame them? Are they the root of these issues? Did those weapons ever realize their deadly poison would be seeping their way into the heart of a little girl named Nivar years later?

Could Saddam have looked into these green eyes and continued to follow through with his attacks?

Many say it’s his fault. There’s no way to say it conclusively. Today, needing someone to blame, I blame Saddam. But even this is not complete.

No, we must go further than Saddam. For even he was driven by something. I can blame only sin. As a follower of GOD, I grieve the effects of our rebellion. I acknowledge these things also break GOD’s heart, and I long for things to be restored. I come to GOD hopeful, believing his promises that he loves his children, like Nivar, far more than I am ever able to.

And so, I hope.

SEND NIVAR TO SURGERY! Nivar has a four-fold set of heart defects known as Tetralogy of Fallot. At eight years old her growth has been stunted by lack of oxygen in her blood and subsequent lack of energy, activity, etc. But a total corrective surgery can still free her up for on-time development as she moves into her ninth birthday in September. Her father has gathered $3,500 from savings, friends, and family to help send Nivar to surgery! We need less than $2,000 to send her in July! Donate the amount of your choice below to get her on her way!

Joshua Gigliotti is a PLC Summer Intern ('09) turned short-term staff who spends a majority of his time with PLC taking exceptional photos of children in Iraq in an effort to humanize Iraqis and portray them as people full of dreams and hope. When his camera is not in-hand, Josh is often found in local tea houses with friends and also enjoys traversing the great outdoors. Follow Joshua on Twitter: @JoshGigs.

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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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