New Houses, New Hearts—How Real Estate Is Saving Lives!
May 24, 2012 by matt · Leave a Comment
Congratulations, Matt & Devin, on the new house!
Our friend Shane Blackshear is in the business of real estate. He’s also in the business of saving lives. Join the growing number of people who are using their business to help save the lives of Iraqi children—write us!”
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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. |
Failure Report: Year 2011 (Part 2 of 3)
May 22, 2012 by Jeremy · Leave a Comment
The only bad failure
is the one from which we fail to learn.
Most organizations put a premium on celebrating successes at the end of every year—we certainly do!
But we also believe that we have a great deal to learn from our failures, so we endeavor to share them and the lessons we’ve learned in hopes of avoiding those same mistakes in the future.
When seeking to tackle intractable problems in an environment like Iraq, missed opportunities, missteps, false starts, and failures are par-for-the-course. There will be no improvement in the political situation in Iraq, in the economy, in healthcare, or in the pursuit of peace without a number of flops and failures along the journey. If we already knew what worked, we all would’ve implemented it by now and moved on.
The truth is, neither the American government nor the Iraqi—neither international nor local NGOs—truly know what works in Iraq. Most of us are making educated guesses and seeking to rightly adapt programs and principles that have proven successful at other times in Iraq or in other parts of the world.
From this point forward, I want to provide you with an annual (and sometimes real-time) assessment of our failures. In absence of such previous reports, I will use a few minutes to highlight our most meaningful setbacks, failures and lessons learned to date.
The three major failures of 2011, to be covered in this series of reports are:
Failure #2: High-mortality Remedy Missions in February/March 2011
Failure #3: The Loss of Our Sulaymaniyah, Iraq Surgery Site as a Major Developmental Partner; Lack of Surgical Capacity Increase As a Result of Remedy Missions Conducted
Let’s get started…
2011 Failure #2: High-mortality Remedy Missions in February/March 2011
In February and March we ran two back-to-back Remedy Missions. One was our second in the southern city of Nasiriyah; the other was our second in the northern city of Sulaymaniyah.
Over the course of four weeks of surgery, mortality rates between the two cities reached 20.5% (7 deaths out of 34 operations).
A few of the losses were very surprising to many on the local and international team and had an extremely demoralizing effect on the team (particularly in Sulaymaniyah). The loss of momentum undoubtedly had a qualitative impact on the care provided as the trip progressed.
Some of the factors were anomalous, such as our lead surgeon contracting an infection in a wound on his ankle that resulted in impromptu surgery inside Iraq to save his leg. But other factors were almost certainly preventable, beginning with case selection and moving to fundamental deficiencies in the hospital equipment and protocols themselves.
A lack of warming blankets, portable oxygen units, a ready blood bank and several other fundamentals led to a less-than-ideal environment for the teaching of pediatric cardiac care. As a result of all these factors and the inherent difficulties of open-heart surgery, mortality rates in the Sulaymaniyah mission reached 22% (four deaths)—unacceptably high by any standard.
None of the deaths were considered “surgical” deaths, in the sense that the child did not die on the operating table, but rather in the post-operative intensive care unit, ward, or—in one case—in the car on the way home after being prematurely discharged by a local nurse the day the international team left the country.
Lessons Learned:
Our international team was very impressed with the local cardiologist for Remedy Mission II in the southern city of Nasiriyah. When it came time to schedule Remedy Mission III in that city, the decision was apparently made to not send a cardiologist on the mission, believing that the local team could handle it. This may have contributed to the imbalanced case selection in RM III and may have led to the situation in which three children died during the course of the mission.
Since that mission, an international cardiologist has been present on every Remedy Mission in an effort to help with case selection and create a balanced schedule of surgeries.
In Sulaymaniyah for Remedy Mission IV, case selection was complicated by the number of stakeholders in the mission. Children were formally and informally (that is, “politically”) put into the mission by the Preemptive Love Coalition, local cardiologists and surgeons, Kurdistan Save the Children (a local NGO), and the Health Directorate.
With regard to Yahya’s case, as described before, I can certainly say that my judgement was impaired when it came to case selection. I can speculate that other entities, in an effort to do right by the friends and patients on their lists, made similar errors in judgement that ultimately skewed the balance of the surgery schedule and its complexities.
When two children died in Sulaymaniyah after the international team left for the airport, we realized for the first time how ill-equipped the local team was to handle relatively simple post-operative care (one child had a positive prognosis in the ICU and the other was already out of ICU and recovering in the ward).
In our post-mission Impact Evaluation Report, we published the following statement:
Our post-mission conferences and deliberations on the matter resulted in the following protocols:
1. A mandatory reduction in “RACHS-1 scores” presented to the international team by the local team
2. A mandatory international ICU team to be left behind after surgeries stop to stave off post-mission ICU deaths and errant discharges
3. A postponing of our next planned mission to the Sulaymaniyah Center for Heart Disease due to lack of preparation of materials, equipment, staff, and protocols
If you have any questions or concerns about this report, the decisions we’ve made, or the direction we are going, please email me at your convenience. I would love to hear from you.
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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. |
Congress Clothing, Selling Shirts & Saving Lives!
May 15, 2012 by matt · Leave a Comment
Congress Clothing is at it again.
Last year they donated a percentage of their profits and gave enough to save a child’s life, and now they’re doing it again!
I sometimes hear people say things like “I wish my work could help people like yours” and I always point them to businesses like Congress. These people saved a life by selling shirts and shoes! Check out their store by visiting here, or why not use your own business to save lives?
Write us and let us dream about it with you!
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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. |
My Take—The Real Meaning of Mother’s Day
May 13, 2012 by matt · Leave a Comment
We’re deviating from our typical Tuesday-Thursday regimen to bring you a Mother’s Day guest post by the excellent Kristine Brite McCormick.
Kristine is an advocate and activist based in Indiana, and she is responsible for many of the lifesaving operations we’ve provided over the years. Take a few minutes to read her story:
This Sunday will mark my fourth Mother’s Day. I have not held my baby in my arms for any of them.
I was pregnant Mother’s Day 2009. I got cards from my husband and mother, and thought about the next year when I’d wake up to a baby and be a “real mother.” My perception of a real mother was so off. In November, I gave birth to Cora, and she was perfect. Except I didn’t know she was born with a broken heart—congenital heart disease.
She died suddenly and unexpectedly only five days later. The last two Mother’s Days have been spent wishing I could hide from the day’s barrage of images of “perfect families.”
For too many mothers across the globe, Mother’s Day is spent not holding our babies, but visiting their grave stone, or in the hospital willing them to get better.
In Iraq, Mother’s Day for thousands of moms means knowing their child’s heart is a ticking time bomb. With every pump of blood, their child’s heart becomes a little more weakened. Without lifesaving surgery, they will die. It’s a fact, this will be the last Mother’s Day for hundreds of Iraqi mothers to hold their babies.
I won’t ever hold my daughter again. Instead, I throw all of my energy into hoping all moms see their babies become adults.
To the mothers sitting bedside in Iraq, hopelessly watching your child struggle, I’m glad the Preemptive Love Coalition is here. Hope is coming. It won’t come in time for all of you, but it’s coming. I promise to do everything I can to make it come faster, and I hope other moms will join me.
That’s the real meaning of Mother’s Day for me, working to make sure every mother gets to spend the day with her child, in the U.S., in Iraq, and across the world.
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To see how Kristine is making lifesaving, legislative change on behalf of mothers, visit her website: www.KristineBrite.com
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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. |
Failure Report: Year 2011 (Part 1 of 3)
May 3, 2012 by Jeremy · Leave a Comment
The only bad failure
is the one from which we fail to learn.
Most organizations put a premium on celebrating successes at the end of every year—we certainly do!
But we also believe that we have a great deal to learn from our failures, so we endeavor to share them and the lessons we’ve learned in hopes of avoiding those same mistakes in the future.
When seeking to tackle intractable problems in an environment like Iraq, missed opportunities, missteps, false starts, and failures are par-for-the-course. There will be no improvement in the political situation in Iraq, in the economy, in healthcare, or in the pursuit of peace without a number of flops and failures along the journey. If we already knew what worked, we all would’ve implemented it by now and moved on.
The truth is, neither the American government nor the Iraqi—neither international nor local NGOs—truly know what works in Iraq. Most of us are making educated guesses and seeking to rightly adapt programs and principles that have proven successful at other times in Iraq or in other parts of the world.
From this point forward, I want to provide you with an annual (and sometimes real-time) assessment of our failures. In absence of such previous reports, I will use a few minutes to highlight our most meaningful setbacks, failures and lessons learned to date.
The three major failures of 2011, to be covered in this report are:
Failure #2: High-mortality Remedy Missions in February/March 2011
Failure #3: The Loss of Our Sulaymaniyah, Iraq Surgery Site as a Major Developmental Partner; Lack of Surgical Capacity Increase As a Result of Remedy Missions Conducted
Let’s get started…
Failure #1: Leadership Indecisiveness on the Case of Six-Year-old Yahya
This was a major lesson in leadership that potentially affects every area of our organizational and team life, couched in the saga of one very specific family.
I was walking home from work one night in Iraq in early 2010, when my phone rang. On the other end of the line was a man, knocking on the door back at my office, in hopes of meeting me and presenting the case of his nephew, Yahya, to me for surgical consideration. I asked if we could meet tomorrow, but he was insistent and there seemed to be great urgency in his voice. Instead of postponing the meeting, I gave him directions to my home and met with him over tea.
From early on, the situation was less than ideal. Yahya had already received one charitable heart surgery and the second one that was being requested was bound to be difficult.
In our 2007-2010 Failure Report, I noted our decision to restrict the complexity of children we sent abroad for surgery after a series of deaths caused us to reconsider our risk tolerance. Yahya was definitely on the high end of our new risk tolerance.
I chose to refuse surgery to the family based on our new priorities.
Months later, after a new check-up, Yahya’s mother and father brought him into our office to inquire again about the possibility of surgery. I’ll never forget sitting with them in my office explaining our decision to decline surgery funding for Yahya.
Then, with all the persistence that you would expect from a mother, she appealed to me again not to turn away their little boy.
I think one thing that non-profit directors and program directors fail to say often enough is this: “I am a human. I’m swayed by the kindness or brashness of our patients and, at times, it heavily influences how I make selection decisions.”
I could not continue to say “no” any longer. I said “yes” (with conditions).
Our surgeon in Istanbul was clear from the beginning that his surgery would require a “valved conduit” (an additional $5,000 expense or more) and licensing agreements in Turkey at the time had caused a shortage of such devices.
Cody Fisher (Development Director) did a great job reaching an agreement with Medtronic providing Yahya with a donated conduit, but the timing of receiving the conduit was still beholden to the licensing agreements that were being worked out in Istanbul.
All these factors together ultimately led to Yahya missing our July 2010 surgery group to Istanbul. We refunded the family’s portion of the money they had contributed for his surgery.
Shortly thereafter, in August 2010, we conducted our first Remedy Mission inside Iraq—our new programatic focus on localized training and development. The mission was such a huge success, I became convinced that we needed to cease all funding for outside surgeries and focus solely on development work inside the country.
But I also felt a sense of commitment to Yahya and his family, who were basically caught in the transitional period between one programatic focus and another.
What I should have done at that point was send Yahya to surgery in Turkey, finish our commitments there, take the free valved conduit from Medtronic, and finish our work in Turkey strongly. What I did instead was place Yahya on an upcoming Remedy Mission and take the Turkey option off the table for the family.
What I didn’t account for very well in that decision was how the complexity of Yahya’s case would fare in a development setting; a setting in which local capacity was far below that which he would have received in Istanbul.
In the chaos of Remedy Mission IV, a number of things went badly. Among them, Yahya’s family probably did not receive the proper explanations that they should have about the risks of his surgery and they probably felt very vulnerable about the decision to go forward with the risky surgery or forever miss their opportunity.
It was difficult to assess all this in real time, in part because I was so hopeful for Yahya and his family. In my optimism, I did not see or recognize a few red flags. But even that is not the whole truth… I remember hesitations—“red flags”—even as I sit here today. I willingly suppressed anything that was not hopeful and optimistic. It seemed noble, brave and right.
But he wasn’t my child.
Yahya’s surgery presented many complications that ultimately required doctors to operate through the night. When Yahya arrived in ICU around 5 or 6 a.m. the next morning, he was deemed stable enough for the surgical team to go to the hotel for a few hours of sleep. Before their bus even arrived at the hotel, though, Yahya had passed away in ICU.
I would not normally include a single death in a year-end Failure Report. My point is not that I feel bad and need catharsis. It’s just that Yahya was different, and not only because he had a name or because his family hosted us for dessert in their home and shared tea in mine. No, Yahya was different because I flipped-flopped on the family so many times. I said “no.” Then “yes.” Then “no” again. And then “yes.” And then he died.
Organizationally, the failure was related to a lesson we were just beginning to identify in our 2007-10 Failure Report: we are not the best qualified to select children for surgery. The suggested way forward at that time is still right: we have handed child selection over to a committee of local healthcare providers and our international surgical team. There will still be deaths that we regret deeply, but they will be less a function of our role and influence in the child selection process.
Personally, the failure was related to my inability to make a decision and stick with it. I always had a bad feeling about Yahya’s likelihood to endure surgery. That was why I denied funding more than a year prior to his death. I had good reason to deny funding. But I went back on my hunch. Fair enough… I wanted to give a family a chance. But I never really got over my fears of his death and that made me unwilling to go all in with the family. I hedged over spending extra money on his expensive valved conduit. And even when the conduit was donated, I found other reasons to delay surgery for fear of spending a lot of money (including the family’s) on a surgery about which I was always suspicious.
Lessons Learned:
1. It’s OK to change one’s mind; but a leadership “Yes” or “No” should mean something. It hurts everyone involved to say one thing, give the impression of support, and never fully get behind one’s own decision. In this case, it played a role in Yahya’s death. He may have died in Istanbul just the same. The death itself is not the failure here. The faulty, character-flawed process by which I made life-altering decisions is.
I said “no.” I should have stood my ground. Or I said “yes” and I should have given that family my fullest “yes” ever. Instead, I said “yes” and stayed on the fence. I won’t do that again.
2. We are not qualified to select children. We are too emotionally attached and we do not possess the knowledge to make a right decision about a patient’s candidacy for surgery. We have handed child selection over to a collaboration between local cardiologists and our international surgical teams.
If you have any questions or concerns about this report, the decisions we’ve made, or the direction we are going, please email me at your convenience. I would love to hear from you.
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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. |
“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!
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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. |
Our Struggle With Mortality
April 10, 2012 by Jeremy · Leave a Comment
When you intend to be in the “business” of saving lives, facing up to death can be a difficult thing.
For my part, in leading the Preemptive Love Coalition, knowing how to admit “failure,” when to acknowledge death without assigning fault, and when to let a death go unreported can be very difficult. The inherent difficulties are compounded by my responsibilities to various constituencies, including (but not limited to) the parents, local health care professionals, local political realities, coalition partners, national political realities, and international donors. At any given time, any one of these entities could be pushing for more or less reporting on a specific item; on a specific death and data set that would include a specific death.
In our January Remedy Mission VIII, a little boy named Yousef that we had grown to really love died in surgery. We held him up as a beacon of hope for the future of all Iraqi children facing congenital heart disease. We told his story and proudly proclaimed his desire to be the next world-famous soccer player. And then we asked you to give your money so that he could be saved by a team of international doctors and nurses. We also promised that his surgery would be an occasion for still more training for Iraqi doctors and nurses in our Nasiriyah program in southern Iraq during the mission (which was to be our sixth mission to the center in just 13 months).
Without exposing ourselves to legal action for disclosing confidential information, it will suffice to say that a local trainee made a mistake that cost Yousef his life.
Because Yousef was the first child in line for treatment that mission, we questioned what the psychological impact would be in widely reporting his death. Again, our considerations involved our international volunteers, local politics, coalition partners and international donors most specifically.
Remedy Mission VIII also featured two first-time nurses from the International Children’s Heart Foundation, both of which provided excellent insights into the local situation and helpful critique about the lack of success and development in the Nasiriyah program.
As we struggled to understand the death (the first mortality in 2-3 missions), our focus was on program development and responses to the conditions that led to the fatal error. Once the mission was over, a few more children had died and reporting on any single one of them was basically more than any of us could stand to emphasize at the time.
A typical response from a surgeon might be “Children have to die in order to build a heart surgery program.” And it’s true. But we are not surgeons. We are just a few normal people who have not held the human heart in our hands and who have not trained for this.
I’m writing to apologize for not reporting on Yousef’s death. We sent a private email to all who donated to Yousef’s account and let them know. But we did not endeavor anything more public.
After the mission a close friend who was still praying for Yousef contacted me without knowing he had died. It was then that I realized how many friends Yousef had and realized that it is not donations alone that tie us each to these children we seek to help. We are drawn in by their eyes, their stories and the hope they exude.
I wish now I would have allowed you to mourn Yousef’s death with us. They are not always easy decisions when juggling the preferences of so many stake holders. But somewhere along the way I gave up trying to push the message out because I did not want to come face to face with the story of his death again.
When you’re in the business of saving lives, “almost” doesn’t count.
We miss Yousef. He was a bright light!
And there are many other children out there who need our help; who are likely to survive; who can greatly benefit from surgical intervention. And there are hundreds of doctors and nurses who desperately need to be trained so they can serve these children on their own.
Thank you for continuing to stand with us…
Jeremy
Please feel free to email me with any questions or concerns.
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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. |
A Playful Hussain In A Serious Situation
March 29, 2012 by matt · Leave a Comment
On our last Remedy Mission, we met a little boy named Hussain.
Hussain’s unabashedly playful approach to everything makes him a lot of fun to be around. In fact, this kid proved difficult not to be around. Even as Hussain waited his turn to meet with the cardiologist, it wasn’t long before a crowd of hospital staff had stopped what they were doing (i.e., stopped working), and gathered around Hussain to enjoy a game or a laugh.
Play-time abruptly ended and things got serious after a supervisor broke things up and got people back to work (though not before he himself had also played a game of catch with Hussain).
It wasn’t long before the boy was in the operating room for a more in-depth look at his heart problem. The cardiologist (pictured below) informed us that Hussain needed surgery, but that he wouldn’t be able to get it until the next Remedy Mission since the current one was all booked up. They had run out of room, but—with your help—we have the opportunity to bring the team back!
That is why we’re campaigning to save Hussain. You have already given $1,505 for Hussain’s upcoming surgery, but we still need your help to reach our goal of $5,000. Please visit this page to help provide Hussain the lifesaving heart surgery he needs, and be sure to come back next Thursday for another Hussain update!
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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. |
Arm-In-Arm With Excellent People—Meet Our Partners!
March 1, 2012 by matt · Leave a Comment
Remedy Mission IX is at an end, and it’s success is more proof that you’re building something amazing here in Iraq.
It started with one little boy all those years ago, and now you are empowering on-the-ground specialists to train and save hundreds (and eventually thousands) of lives—you’re making all the difference!
So we thought we’d re-introduce you to our larger team in Iraq so you can know who does what around here.
The International Children’s Heart Foundation, or ICHF for short. These are our medical partners. Each mission they draw from an outstanding collection of volunteer nurses and doctors who are willing to spend their vacation time working for free in developing countries. How ’bout that for a holiday!?
Living Light International (LLI) completes this triumvirate by acting as our cultural compass. Their guidance and know-how make these surgical missions possible, and they’re incredibly well-connected. They make expansion to new frontiers and hospitals in Iraq possible, and they’ll even teach you some Arabic if you ask nicely.
Teaming up with these two has already left hundreds of families with now-healthy children, and we’re excited to save many more down the road!
Onward!
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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. |
“…The Feeling of Being About to Reach My Dream!”
February 13, 2012 by matt · Leave a Comment
“But nothing else makes me feel like this; just the feeling of internal happiness; the feeling of being on the short way to being a cardiac surgeon—even a beginner one—the feeling of being about to reach my dream!”
This came in an email from one of the local surgeons receiving training right now in southern Iraq! This doctor’s excitement is so contagious—he even makes me want to learn more about medicine. Thank you for empowering his compassion for his compatriots!
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We are now halfway through our ninth surgical mission in Iraq, and the excitement has yet to die down. The press are swarming our break room even as I write this, and we’re looking into every lens and delivering the same message: there is a Coalition that is committed to eradicating this backlog of children in need of surgery!
Seven days in, and we have already seen ten children receive surgery. Come back tomorrow to meet one of my favorites!
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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. |
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OUR BLOGGERS
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Matt Willingham is the PLC press secretary and writes primarily on politics, history, general updates and visual peacemaking through photography and film. |
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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. |
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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.