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


----------

 Q: What are you trying to accomplish?

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

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

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

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

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

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

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

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

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

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

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

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

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

 Q: Any other costs?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Jeremy Courtney Founder, Executive Director Twitter: @Jeremy_Courtney

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

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

Watch Our Animated Manifesto!

April 24, 2012 by matt · Leave a Comment 

Over the last few months we’ve seen an incredible influx of new readers and supporters, so it seemed good to put our most informative and successful video to-date back on the blog.

Whether you’re brand new or if you’ve been here a hundred times, watch it and let me know your reaction. Is it naive? Spot-on? Over-the-top? Email me!

As PLC's Press Secretary, Matt Willingham writes, reads, edits, tweets, updates, and works with a camera so as to connect hearts and minds to Iraqi children in need. On the side, he likes reading stories, devouring the great food his wife cooks up and exploring DSLR work. He's also mildly obsessed with Twitter: @mehtin.

“An Idea Worth Living”—Hear Jeremy Courtney Speak At TEDxAustin!

April 12, 2012 by matt · Leave a Comment 

“If we live skeptically and only by the principles of risk-management, I fear we’ll miss the opportunity to remake the world around us.”

On a recent trans-atlantic trip, Jeremy Courtney was invited to share about the concept of preemptive love at TEDxAustin’s 4th annual conference.

This talk differed from his TEDxBaghdad talk as he shared new stories and invited attendees to consider how they personally might “do preemptive love.” And the video presents the same question to you: what can you do—small or large—to remake the world today?

After watching the video, would you share it? Your ‘shares’ and support help make our work possible—they can help save lives!

As PLC's Press Secretary, Matt Willingham writes, reads, edits, tweets, updates, and works with a camera so as to connect hearts and minds to Iraqi children in need. On the side, he likes reading stories, devouring the great food his wife cooks up and exploring DSLR work. He's also mildly obsessed with Twitter: @mehtin.

Meet Hussain!

March 13, 2012 by Cody · Leave a Comment 

On our last Remedy Mission inside Iraq, we were able to save the lives of seventeen Iraqi children! We also gave thousands of hours of training to Iraqi heart surgeons and nurses. But we ran out of time to save Hussain.

According to Iraqi doctors, it was illegal to help children with Down Syndrome under Saddam Hussein’s regime. Saddam viewed children like Hussain as a “waste of resources.”

But Downs children are God’s children, and they are important members of society. Today Iraqi doctors are ready to help save Hussain and so many more beautiful children with Down Syndrome. And we’re ready to help give them the training they need to do exactly that.

By giving Hussain his shot at lifesaving heart surgery, you will be telling him and so many others that they matter; telling them that we value them and that we’re in this together; telling them we care.

So, in honor of World Down Syndrome Day on March 21st, will you help us save Hussain and his friends by giving to our next Remedy Mission today?

Hussain is waiting! Give today to show that he and other Downs children aren’t a “waste of resources.”

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

Believe It Or Not, Things Are Looking Up For Hamma!

February 10, 2012 by matt · Leave a Comment 

This little guy is having a rough day.

And we’ve all been here, haven’t we? Sitting on some cold table with a bunch of strange people poking and prodding. It’s not the kind of photo we show you a lot, but faces like this aren’t uncommon to our work.

With a few exceptions, kids generally hate hospitals—this little guy even more than most. His name is Hamma, and his problems started about a year ago when doctors told his parents of Hamma’s need for heart surgery.

As if that weren’t enough, Hamma fell down the stairs a couple weeks ago while chasing his sister and broke his nose. I’m not sure which was more painful: the shame of being bested by your little sister or actually smashing your face in, but add his oxygen-deprived blood and the fact that he hadn’t eaten all day and this is the kind of face you get.

But there is a light at the end of Hamma’s tunnel! In fact, I think his best days are ahead of him, but he needs surgery first.

I sat with his parents in their hospital room and told them why we’re here, I told them about you, and I explained that the doctors have high hopes for Hamma’s surgery.

He is in line for surgery—come back tomorrow and I’ll let you know how it goes!

As PLC's Press Secretary, Matt Willingham writes, reads, edits, tweets, updates, and works with a camera so as to connect hearts and minds to Iraqi children in need. On the side, he likes reading stories, devouring the great food his wife cooks up and exploring DSLR work. He's also mildly obsessed with Twitter: @mehtin.

Just Hours Before Her Surgery, Fatima’s Mother Says, “This is a gift from God!”

November 16, 2011 by Lydia · Leave a Comment 

I had the hardest time deciding which picture to use to introduce you to Fatima. This last week she’s been such a star for the camera—aka, exactly the kind of kid I love! In fact, if you didn’t see her in Remedy: The Flipbook you should stop reading and go do that here. But Fatima’s charm goes beyond her camera antics. There’s no way to describe it except this: she is so full of JOY. She’s here with her mother, and the two of them just fuel each others laughter all day long. It’s been so much fun having the two of them around.

I got some of the back-story on Fatima and her mother–want to hear it? Fatima is the youngest of four. Her father is out of work, and her mother works from home as a seamstress to make ends meet. When Fatima was born, the doctors told her mother that the hole in their daughter’s heart was the fault of the war. A remnant of the violence of the foreign countries who had attacked their homeland for so long.

Like so many other families, their only option would be a costly trip abroad. But at a seamstress’s salary, she knew she could never pay for this trip. “We could only give it over to God,” she says.

Several months ago they saw an ad on TV; foreign doctors were coming to her! Forget leaving the country—she wouldn’t even need to leave her city! She couldn’t believe it, but “This,” she says, “this is a gift from God.”

Fatima is just hours away from her life-changing operation. Why don’t you use these next few hours to share her story with a friend?

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

In the News: “Rebuilt Iraq Hospital Plans Surgery On Infants”

July 29, 2011 by matt · 2 Comments 

Yahoo! News recently released an article about the rebuilding of Iraq’s largest heart hospital. After being burned and looted during the invasion of Baghdad in 2003, the hospital was deemed “beyond repair.”

But they underestimated the doctor’s commitment to their patients and to their hospital.

Click here to read the entire article. This article is just one example of how Iraqi cardiac hospitals aren’t just burnt-out and “beyond repair,” they’re proof that you and I can improve Iraq’s medical infrastructure.

As PLC's Press Secretary, Matt Willingham writes, reads, edits, tweets, updates, and works with a camera so as to connect hearts and minds to Iraqi children in need. On the side, he likes reading stories, devouring the great food his wife cooks up and exploring DSLR work. He's also mildly obsessed with Twitter: @mehtin.

In A Word: After-Party

July 13, 2011 by Jeremy · 1 Comment 

Parzheen waited 5 years for a remedy, her surgery lasted a few hours, and her after-party will go on for a lifetime. Click on the video above to watch Parzheen’s journey from surgery to after-party!

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

The Surgery Was A Success! After Much Difficulty, Mohammed & His Mother Are Going Home!

July 10, 2011 by Alex · 1 Comment 

Mohammed – quite possibly one of the cutest kids in southern Iraq – is currently resting after his successful surgery!

On our last day at the hospital we found out that Mohammed has suffered through much more than a failing heart; just before he was born his father left their family, and his mother was left to raise him alone.

That’s a big deal in a region like southern Iraq. It’s not easy for a woman to take on that kind of responsibility alone, which is why I feel such respect for Mohammed’s mother.

Like so many single mothers, she worked hard to raise an amazing kid, and she helped get him to the place where his life could be saved.

So, as we near the end of Remedy Mission VI, we’re celebrating Mohammed’s successful surgery, but we can’t really celebrate his life without acknowledging the hero who has always stood behind him.

We’re excited that Mohammed’s heart is healing, and he can now grow into a man capable of caring for the woman who sacrificed so much for him.

So from Mohammed, his mother, and all of us – thanks for saving his life!

Our Partners:

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.

Noor’s Heart Is Mended And There Are Teethmarks To Prove It!

July 6, 2011 by Cody · 2 Comments 

The doctors fully repaired Noor’s heart!

She’s thriving in the hospital ward right now as she shows us a side of her that we’ve never seen before. The difference between the Noor before the surgery and the Noor now is unmistakable. Before, we could barely get photos of her awake and active, but now we can’t catch her holding still.

Little Noor has left her mark on all of us…including our hospital equipment! We admit that this is NOT how you show the doctors how well you’re breathing after your surgery. But her teethmarks are another good sign that Noor can’t wait to get out of the hospital and back to being a kid!

Our Partners:

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

Mohammed’s Still Smiling And Is One Day Closer To His Remedy!

July 3, 2011 by Alex · 2 Comments 

My friend Mohammed is back!

Mohammed made me feel so welcomed when we first arrived, and I’ve missed him as he’s been out of the hospital these last few days. But now he’s back and brightening everyone’s day with his contagious smile!

Besides seeing my new friend again, something else has me smiling all day: hearing that Mohammed is scheduled for surgery this week!

Each kid we meet here captures our hearts, but there’s something extra special about hearing how the remedy is coming to a little boy or girl you have a personal connection with. I can’t even imagine how special the feeling of hope and excitement must be for each of these kids, their parents, families, friends, and communities all over Iraq.

Thank you for bringing that feeling of hope to Iraq, and to my little friend Mohammed!

He’s one day closer to his remedy. Get ready!

Our Partners:

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.

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OUR BLOGGERS

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

Preemptive Love Coalition provides lifesaving heart surgeries for Iraqi 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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