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)

Have You Ever Seen How Much It Costs To Save 20 Lives? Here Are The Numbers:

June 6, 2011 by Jeremy · 1 Comment 

As we’ve looked across the landscape of organizations working in Iraq and around the world we’ve found ourselves wanting to know more about how their money is spent. We figure you are the same way – and we think you deserve to know. The scandalous press and allegations surrounding big name do-gooders, their books, and their organizations have all caused us at PLC to ask honest questions about how we can be fully transparent with you about your donations and our management of them in Iraq.

So here are a few real-time financial notes that will remain here for posterity’s sake:

- PLC spent $41,068.38 for airfare and hotels for Remedy V

- PLC spent $30,000 to the International Children’s Heart Foundation (ICHF) to procure their surgical expertise for this mission

- ICHF made approximately $20,000 in in-kind medical gifts to the mission (directly to the hospital in southern Iraq; not on our balance sheet)

- We have not finished tallying the field expenses for Remedy V yet but we anticipate it will account for an additional $1,790-$2,000

- Our partners in southern Iraq budgeted $1,500 for educational instruction

- More than $1,620 in visa expenses were covered directly by the Iraqi Ministry of Health (MOH) in Baghdad

- Security and transportation was provided to us, free of charge, by the MOH (worth, perhaps $10,000 as an in-kind contribution)

- Food, housing, and all local accommodations were provided by the MOH (worth more than $20,000 as an in-kind contribution)

We estimate the total cost of this particular mission to run all parties approximately $133,361. Our agreement with the MOH will subsidize approximately 77% of those costs, with roughly $2,800 for this particular mission coming from PLC’s international donor pool.

Our next mission – Remedy VI – in southern Iraq is scheduled for June 25th.

Here’s the bottom line to all this: you are indispensable to our work. We cannot help Iraqis reach their desired vision for the future without you. We cannot eradicate the backlog of untold thousands of children waiting in line for lifesaving heart surgery. And we cannot create the systems they need to do this work on their own without you.

But….

You are not alone! This is not a “hand-out” program in which you unload your hard-earned money into a foreign country (no matter how poor or decimated), without calling on local families, organizations, and government to carry the majority of the financial burden. This is what we mean when we talk about development. This is what we mean when we talk about graduating a program from foreign aid.

They cannot do it without you. But hopefully in the next few years that will no longer be true. Stay tuned in the coming months as we begin publicly exploring our EXIT STRATEGY and what exciting promises that holds for our dear friends here in Iraq!

With you,

Our Partners:

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: @Jeremy_Courtney.

You’ve Sent Another Round of Remedy To Iraq

May 24, 2011 by Jeremy · Leave a Comment 

One of my favorite things about working for the Preemptive Love Coalition is the chance to stand before you every few weeks and give a transparent account as to how we are putting your hard-earned money to work in Iraq to benefit the thousands of children who are counting on us to help develop cardiac care on their behalf.

Today I’m back in southern Iraq, a few hours outside of Basra, for Remedy Mission V and it is such a joy! (Because we blog and Tweet in real-time we are withholding the name of the city to minimize any risk to our local and volunteer staff). In the last 8 months we have given more than 95 children a shot at lifesaving operations and invested more than 20,000 cumulative hours in both didactic and hands-on training for Iraqi doctors and nurses.

One of the most exciting things about Remedy V is the slower pace of surgeries and training. In a world where bigger and faster is usually better, I am really excited to slow things down this trip for the sake of greater learning and better results.

In past missions we took a faster pace, kicked the wheels of the system a little bit, stretched it to its limits and obtained a very clear sense for what was possible and what was not possible at this developmental juncture. With two full missions at this particular hospital under our belt we have more clarity than ever about how we should be proceeding. So the pace of surgeries on this mission, while slower than previous trips here, seems to be yielding exciting opportunities. Local Iraqis are working hard yet are also less stressed than previous trips because the pace and complexity of surgeries is more in line with their current developmental needs. Our volunteers from America, the United Kingdom and Europe are finding they have more time to teach in the down times between critical care.

And all of this amounts to more lives saved and better education for Iraqi doctors and nurses who are giving so fully of themselves to learn to care for children facing life-threatening heart defects.

Stay tuned this week for amazing stories of your life-changing donations hard at work!

Our Partners:

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: @Jeremy_Courtney.

Death Will Never Conquer

March 4, 2011 by Jeremy · 5 Comments 

Yahya passed away early this morning after an all-night surgery. It was a surprise to everyone. When he was admitted to the ICU there seemed to be plenty of confidence that he would be just fine. But within just 30 minutes of admission his heart gave out and all efforts to revive him failed.

I still remember the first time I was introduced to Yahya. It was over a year ago. His uncle called my cell phone and said, “I’m at your office, I need to talk to you about a sick kid.”

It was after hours and I was already at home. But I could hear the urgency in his voice so I invited him to my home for tea. He arrived and made an impassioned plea for Yahya – his brother’s son. I was leery of helping Yahya after reading his reports – we had seen some children with complex heart defects like him die abroad and I couldn’t stand to put a family through that drama again. I did my best to avoid commitment and send Yahya’s uncle into the night without any solid hope for his nephew.

The following weeks were filled with phone calls and followup from the family, “Please help our boy!”

Finally, I met Yahya’s mom and dad and the little cutie himself. As they sat in my office they pled with humble urgency. They weren’t forceful. They weren’t rude. But they applied enough pressure on me that I couldn’t say “no” any longer. They made it abundantly clear that they understood the risk of his surgery and that they wanted it badly enough to endure whatever might come.

One of our core values as an organization is that we give “hope to the hopeless.” What that means is that we try to balance our impulse to be “last chance” people with our instinct to be “long-term” people. We held back on Yahya, wondering if it would give him long-term viability. But we ultimately dove in with Yahya’s family because we were their last chance. No one else would take on the risk.

We solidified this core value in November 2009 when we asked you what to do about a little boy named Ramyar. We asked you if you wanted us to apply your money in a high risk surgery or save it for a “sure thing.” You overwhelming said, “We want this Coalition to be about hope for the hopeless.”

We haven’t looked back since. We are the Last Chancers.

Still, committing to Yahya was full of complications. His surgery in Turkey was canceled due to an unavailability of an expensive assistant device. In fact, there was even discussion as to whether or not he should be included in our current Remedy Mission. Ultimately, we let the family themselves decide.

Our local cardiologist, along with our American surgeon, explained the risks of surgery, the option of waiting, etc. etc. Yahya’s dad was given a 50/50 chance of survival for little Yahya. Understandably, they wanted to give it a try. They couldn’t stand the risk of feeling like they had an opportunity to try and let it slip through their hands.

What would you have done? I have two kids – 5 and 3 years old. I have no idea what I would have done.

During Yahya’s surgery our Family Services Director, Jessica, sat down in the ward with all the parents whose kids were either in surgery or in critical condition in the ICU – those families whose kids were not “out of the woods” yet. As they asked questions about our organization and how long we’ve been working here, she recounted for them our past of taking children outside the country to significantly nicer hospitals than this Iraqi version in which we currently work. She told them about excellent American-trained Turkish doctors and fancy, pristine protocols abroad. Without fail, every family was so grateful for the chance to receive surgery at home. Let the Turks have their pristine hospital. “What if our child were to die abroad?” That would be a burden far too great to bear.

You gave Yahya’s family a chance that no one else would have. He had been rejected by every other opportunity out there. They are grateful to you. They will rest knowing they gave it their all for their only child.

And this is what we find almost universally – parents who just want a chance. And that’s what Remedy Missions are all about. We could continue to export kids to world class facilities, but who would invest in the future? We could continue to select the easiest children that almost never die, but does that make us any less culpable for the kids we pretend aren’t knocking on our door?

Was this a wasted opportunity? Did we waste the $670 that it cost us to provide Yahya surgery?

I used to feel that way when a child died in Turkey or Jordan or Jordan. I don’t feel that way anymore. Yahya’s death – though a terrible loss – was still an opportunity for local doctors to learn an innovative technique that they will be able to apply in future situations. His death was almost certainly unrelated to the particular tactic used in attempting to heal his heart. Educational gains always have significant costs. Before we only had the “we gave this child a chance” platitude. It’s not untrue. But local learning is an equally deep reason why your gift for Yahya made a difference.

Thank you for your willingness to stick with us through life and death. The gains that are needed here will not be made without significant risk and vision. We deeply appreciate your demand that we be the people of the last chance. I think it’s easier to sleep knowing we tried, than knowing we played it safe just so we could publish numbers and blog posts that seem more palatable.

With you,

Jeremy Courtney

Executive Director

email: http://scr.im/jcourt

+1 (806) 853-9131

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: @Jeremy_Courtney.

You Just Helped More Kids in 12 Days Than Any 12 Month Period in Our History… for Less!

September 13, 2010 by Jeremy · Leave a Comment 

Deeya is alive and doing well at home today because of the surgery you provided for her in Iraq!

Wow! What a phenomenal trip it has been these last few weeks as you have brought a new remedy to the children of Iraq through the surgical and nursing team of Dr. William Novick. It’s high time we update your impact to help Iraqis make a better future for themselves and their children.

The total expense for our first Remedy Mission was approximately $90,000. This amount was further subsidized by the Director of Health in our city and the Kurdish Regional Government in Washington D.C., and the International Children’s Heart Foundation. The balance was underwritten by you!

This family was not yet chosen for surgery… they are still waiting for our next Remedy Mission.

Locally, Remedy Mission was a great success. We ended the week at dinner with the governor and the health director where they invited us to start our next Remedy Mission as quickly as possible. When we suggested May 2010 as a next date, all the surgeons and the health director rallied together to urge us to begin again in February instead.

Our current proposal is a five year plan comprising four trips per year to make the Sulaymaniyah Cardiac Center a premier facility in the region that is able to perform 12-14 surgeries per week without foreign assistance. We estimate that this will cost $1.5m and we are currently talking with the local authorities in hopes that they will choose to shoulder the majority of that expense.

During Remedy Mission ICHF and local surgeons performed 25 corrective cardiac procedures. Put differently, we helped more kids in 12 days than we have in any 12 month period to date… at a massive savings compared to our work in Iraq… with hands-on training for Iraqi doctors and nurses! A typical all-inclusive surgery in Istanbul costs us $10,000 (after subsidies). That expense is usually shared among the family of the child, local and international donors. The typical PLC international donor portion of a surgery in Turkey is $3-5k.

Cody Fisher reviews the list of kids who received surgery and kids still in line for February 2011.

The numbers for Remedy Mission look much different. Not only are we able to work in partnership with others more during Remedy Missions, but every surgery represents a local development and training opportunity. The all-inclusive price for all partners was approximately $3,600 per child (compared to $10k in Istanbul and much more in the States or Europe).

Remedy Mission has taught us a lot about being fiscally and developmentally responsible. Therefore, in an effort to redouble our commitment to long-term local solutions, we will be increasing our Remedy Mission funding in hopes of facilitating four Remedy Missions in our current city in 2011.

The following families are still waiting in line for our help…. Will you be the remedy? Donate the amount of your choice below to get our next Remedy Mission off to a strong start!

With you,

Remedy Missions are international pediatric heart surgery teams that we bring to Iraq to to perform lifesaving heart surgeries and develop the infrastructure for the future. If you’re on Twitter this week be sure to use the #Remedy or #RemedyMission hashtag to describe all the good news coming out of Iraq this week via @preemptivelove and @babyheart_org. If you’re on Facebook, “Share” this story with the button below.

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: @Jeremy_Courtney.

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

August 3, 2010 by Jeremy · 6 Comments 

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

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

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

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

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

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

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

Jeremy Courtney lives and loves in Iraq as a co-founder and Executive Director of the Preemptive Love Coalition. He's also the father of two spectacular children, and married to the lovely Jessica Courtney. When not absorbed in PLC work he can be found writing songs and singing about hope and future. Follow Jeremy on Twitter: @Jeremy_Courtney.

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.

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.

The Discipline of Listening

April 28, 2010 by Jeremy · Leave a Comment 

“Iraq will become a country, if it has not already done so, where it is advisable not to have children,” says the Iraq Minister of Women’s Affairs, before speaking of a gravedigger in Fallujah who digs 4-5 graves daily for children, most of whom are deformed. While official numbers say the overall incidence congenital birth defects is only up “2-3 per year,” there is strong evidence to the contrary.

What should our response be when scientists and medical professionals suggest the chemicals comprising Coalition weapons used throughout the war left behind a legacy of newborns with scales for skin, two heads, spina bifida, or wreckage where the heart should be? It conjures memories of Saddam Hussein’s use of chemical weapons on the Kurdish and Shi’a populations of Iraq, which also left a heightened incidence of birth defects still prevalent today. When we add intra-family marriage and underdeveloped prenatal care to the equation, the questions of value-based impact in Iraq become overwhelming:

What constitutes high-impact for children born with congenital disorders? Are palliative, non-corrective interventions an advisable investment? Is a policy that selects only those who are most-likely to receive a “total correction” preferable? Is that fair? Is it right? Does it say something about our values when we invest in one over another?

When financial and human resources are limited, we are thrown quickly into a life-and-death discussion in which we not only triage children; we triage our very values.

Most everyone agrees “women and children first.” But if every child cannot be served, how should we spend our finite resources to make the most significant impact? What values should guide us?

It’s a highly personal question. But it should also be a communal question. We should not be left to our best individual guesses, nor guided by our whims and fancies. We should not fail to think about impact, priority, and purpose in our giving and serving. Research shows that most give for personal reasons before giving for the sake of others (and, I’d suggest that there is little wrong with that… see article one, two, and three). I might give to assuage my guilt or to be a part of something significant. I might give because I believe it is fundamental to my faith. I might give because I want my children to be marked by a character of deference. And, yes, I might even give because I want children in Iraq to live; to know that I was a part of that; to know my life matters.

But in order for me to really know my gift matters – that is, to be sure that my gift is significant beyond making me feel significant – I must understand the context of the problems I seek to solve with my giving. That is why the Discipline of Listening is crucial for any act of giving to be an act of love. The impulse to give may arise first in my heart from my need to feel significant, but an act becomes truly loving when it moves beyond personal preference and seeks to maximally benefit the recipient. And in order to know what benefits the community of recipients, we have to listen well.

In Iraq we face this every day. In whom should we invest our limited resources: (a) the child with the best story, (b) the child with the highest urgency, (c) the child with the greatest likelihood of long-term vitality? We’ve arrived at our values through years of listening to the community we serve–and we are constantly reevaluating them. So when it comes to selecting a child for lifesaving heart surgery, we live in the tension between our impulse to be “last chancers” and our instinct to be “long termers.” But we prioritize according to a regularly scrutinized impact matrix derived from the Discipline of Listening.

When facing 24,000+ children in Iraq waiting in-line for lifesaving heart surgery*, there is great risk in rushing to action, which can lead to an unnecessary duplication of services, redundancy of resources, and – most critically – the failure to leverage indigenous passion toward long-term, local solutions.

But when we practice the discipline of listening in our local and global communities, we increase the likelihood that our actions will not only be well-intentioned, but that they will actually be effective and loving.

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: @Jeremy_Courtney.

Sara is Doing Great Back in Iraq One Month After Surgery

April 25, 2010 by Jessica · Leave a Comment 

Sara and her father came by our office on their way to a check-up with the local cardiologist, Dr. Aso Faeq.

It was a joy to see her and talk with her. She is doing great and is enjoying a little time off from school. We talked about picnics and the results of recent elections. They told us in detail of their visits to Deelan’s family, who also went to surgery in March. They amazed me with their love for this little boy they didn’t even know until they met at the airport on their way to Istanbul. It is great to see healed hearts, bright futures, and relationships formed (and/or sustained) across some recent – and some more historic – barriers between Turkmen, Kurd and Arab in the city of Kirkuk.

We ended our time with them celebrating with the fresh baklava and chocolates they brought to say “thank you.” Thanks to all of you Woodway college students Sara is alive and thriving with her newly healed heart.

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

ADOPT A CHILD

Churches, universities, and other organized groups were the backbone of our large fundraising efforts in 2009—and now we’re looking for at least 12 churches, mosques, synagogues, universities, youth groups, etc to adopt an single Iraqi child to raise life-saving awareness and funds on his/her behalf. Group goals usually range between $5,000–10,000—though we’ve seen junior high groups raise over $8k and college students pull together $30k! Email cody@preemptivelove.org or call us at (805) 245-4870 to discuss your group adopting a child for surgery.

Jessica Courtney lives and loves in Iraq as a co-founder and Family Services Director of the Preemptive Love Coalition. She is also a mother of two children and is married to PLC's Executive Director, Jeremy Courtney. When not absorbed in caring for Iraqi children and sharing life with Iraqi families, she enjoys sewing and scrapbooking.

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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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