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)

To Know Honya Is To Love Honya

May 4, 2011 by matt · Leave a Comment 

Honya was the first child I met when I visited PLC back in ’09, so I was excited when Honya’s father invited us to picnic with their family. Not surprisingly, she’s still as loveable as ever, and it was great to see her so healthy and happy over a year after surgery!

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.

She’s Always Smiling

June 25, 2010 by Lydia · Leave a Comment 

“She’s Always Smiling” The Story of Honya Mahdi from Preemptive Love on Vimeo.

Honya Mahdi first came to the Preemptive Love Coalition 7 months ago. Today she is alive, happy and healthy, thanks to your support!

www.preemptivelove.org

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.

Photo of the Day

June 24, 2010 by Lydia · Leave a Comment 

Little Honya peeks out from behind her mother in the kitchen, so cute! This is from our most recent home visit with Honya, she is so healthy and happy!

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.

Photo of the Day

June 15, 2010 by Lydia · Leave a Comment 

Baby Honya has recovered wonderfully from her heart surgery! We checked in with her this week and she is doing great. At 15 months her teeth still haven’t grown in and her parents lovingly refer to her as “grandma”.

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.

Fighting for Families

December 8, 2009 by Cayla · Leave a Comment 

When a child is chosen for surgery, their family is adopted by a member of the PLC team. This person makes it their goal to do whatever is necessary to defend the family in this time of vulnerability. They are the family advocate.

The care offered to the family goes far beyond a healthy heart. When I visited the team in Iraq a month ago, I was able to see this care first hand on various home visits I made with PLC’s family advocates.

Here are some examples of what I saw:

• Honya went to Istanbul for surgery in November. Her advocate sat with her parents to explain what the process would be like and what to expect in the hospital.




• Heran needs a follow-up surgery but must gain weight before that’s possible. Her advocate has been visiting weekly, checking her weight and encouraging her closer to this goal.




• Taban has completely recovered from her surgery but lacks motivation in school. Her advocate met with the school board, persuaded them to let her enroll, and continues to support her education.




• Zana has also been doing well, but his mother was keeping him from school for fear he would turn up sick again. After some reassurance, she allowed him to begin his studies.




• Shwana has fully recovered and is doing great, but others in his family are still in need. His family advocate is in the process of acquiring a wheelchair for his disabled cousin and was able to give helpful exercises to his grandma who recently had a stroke.

  
  

PLC does so much more than just heart surgeries; they truly care for the Iraqi people and work to show them that they matter. I was astounded to see how much is invested in the lives of the children and their families and how big of a difference it really makes.

HELP PLC IN THEIR ADVOCACY ON BEHALF OF IDREES BY GIVING TO HIS SURGERY IN HONOR OF A FRIEND BELOW:

	Idrees is slated for surgery in January 2010. PLC will be collecting money for his life-saving surgery throughout the Thanksgiving and Christmas season. What a chance to make a profound difference in the life of a child and his family!
	GIVING IN HONOR OF ANOTHER In honor of a friend or family member, donate the amount of your choice to fund a January surgery for Idrees by entering it in the field below. PLC will send you a Christmas card about Idrees along with a Preemptive Love Coalition “Hope for the Holidays” magnet as a physical expression of your gift on behalf of another. Donation:

Cayla Willingham is a Family Advocate in PLC's Followthrough program. When she isn't spending time with families, she enjoys cooking up amazing food, hosting friends, haggling at the bazaar, and learning Kurdish.

Filed under: Family Participation, Heart Surgery, Heran, Honya Mahdi, School, Shwan, Taban Ali, Zana Tofiq

Honya is Doing Great Back at Home in Her Village in Iraq

December 3, 2009 by Jessica · 1 Comment 

We visited Honya and her family this morning and she looks great. The incision from her amazing heart surgery is almost completely healed and she finally has enough energy to learn to sit up on her own and to crawl around for the first time. Only 20 days after surgery she is acting like a normal 9 month old and her fingers and cheeks have a wonderful pink hue. We watched family videos from the last 4 days of the holiday here in Iraq.

Follow 9-month-old Honya on Twitter: @honyamahdi. Subscribe to Honya’s updates via RSS HERE. Follow Honya’s thread of longer stories (with pictures & video) on the PLC blog HERE.

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.

Filed under: Heart Surgery, Honya Mahdi, Our Kids, Peacemaking, Surgery Updates

Baby Honya’s last day in the Hospital Before Going Home to Daddy

November 16, 2009 by Joshua · 942 Comments 

Its been no secret we think this little baby is adorable. And we know you do, too. I mean c’mon, look at this girl.

This is harder than it should be though.

We know its not the way this is supposed to be….we’re supposed to be excited about seeing her leave, going home to her family, back to normal life….but we’re going to miss seeing her each day!

Today, she is well rested and smiling a lot. Today, we are praising God for a successful surgery and the new life that has been given. In fact, today we’re grateful for our Followthrough program and the fact that we will continue to see this little girl grow up into the hope & future that has been provided for her.

And we’re grateful for you… because without you we could not have made this happen!

Follow 9-month-old Honya on Twitter: @honyamahdi. Subscribe to Honya’s updates via RSS HERE. Follow Honya’s thread of longer stories (with pictures & video) on the PLC blog HERE.

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.

Filed under: Anadolu Sağlık Merkezi, AtlasJet, Heart Surgery, High Pulmonary Pressure, Honya Mahdi, Our Kids, Partnerships, Peacemaking, Surgery Updates, VSD

Uneventful Days in a Hospital After Heart Surgery are the Best Kind

November 11, 2009 by awara · 468 Comments 

Today was a down day… not much to report on Honya and Vary except that everything is going according to course. Because of the down day, some of us worked from the hospital while our American staffed worked from the guesthouse in Istanbul on some long-term projects for PLC.

But thanks to modern technology and the incredible access to WiFi at the Anadolu Medical Center, the staff from the guesthouse were able to “conference call” with the mothers and the two girls to check in on their well-being throughout the day!

Follow 9-month-old Honya on Twitter: @honyamahdi. Subscribe to Honya’s updates via RSS HERE. Follow Honya’s thread of longer stories (with pictures & video) on the PLC blog HERE.

Follow 2-year-old Vary on Twitter: @varybahman. Subscribe to Vary’s updates via RSS HERE. Follow Vary’s thread of longer stories (with pictures & video) on the PLC blog HERE.

Awara Hassan Mama is a Regional Development Officer for the Preemptive Love Coalition in charge of creating local solutions to local problems in Iraq among his compatriots and for the sake of our constituents. Awara often travels abroad with PLC children to surgery and serves as a translator and a key cooperator between communities in conflict.

Filed under: Anadolu Sağlık Merkezi, Heart Surgery, Honya Mahdi, Hypertrophied Left Ventricle, Misdiagnosis, News, Our Kids, Partnerships, Peacemaking, Surgery Updates, VSD, Vary Bahman

Honya is Breathing Entirely On Her Own Just Hours After Surgery

November 10, 2009 by Joshua · 420 Comments 

Baby Honya is sleeping calmly in ICU, waiting for doctors to clear her to release to her room. Her oxygen levels are great off room air and the strength of her own lungs! And her pulmonary pressure is (so far) entirely under control!

Follow 9-month-old Honya on Twitter: @honyamahdi. Subscribe to Honya’s updates via RSS HERE. Follow Honya’s thread of longer stories (with pictures & video) on the PLC blog HERE.

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.

Filed under: Anadolu Sağlık Merkezi, Heart Surgery, High Pulmonary Pressure, Honya Mahdi, News, Our Kids, Partnerships, Peacemaking, Surgery Updates

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