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)

Update From The O.R.—Welcome To Basra!

December 7, 2012 by matt · Leave a Comment 

With newness there often comes a beautiful feeling of hope.

New equipment, new partnerships, new facilities; this is the first, fresh, new mission to Basra, and everyone is excited about what’s ahead. There’s no doubt that challenges are coming. There will be valleys, to be sure. But this week is a peak that we’re going to celebrate.

So take a minute to watch and share this video with your friends. We hope you’ll be drawn in to this 30 year-long dream that is just beginning to come true and that you’ll stick with us for all the videos—both happy and sad—as we work alongside the doctors of Basra.

More to come…

Our Partners:

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

A Quick Shot of Hassin’s Operation

November 20, 2012 by matt · Leave a Comment 

Doctors are literally putting their heads together to save Hassin‘s life. Dr. William Novick of the International Children’s Heart Foundation (on the left in red) is teaching the local Iraqi doctors how to correct Hassin’s heart defect.

Please pray for this boy’s recovery. More to come…

Our Partners:

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

Who’s Who In The ICU—The Respiratory Therapist

November 15, 2012 by matt · Leave a Comment 

Quiz time! What kinds of nurses and doctors does it take to pull off one of our Remedy Missions? Any guesses?

[Imaginary] you: “Uhhhh… a surgeon. And nurses. Aaand…others?”

That’s what I thought. You guys are insanely compassionate do-gooders who save lives, but we’ve failed you. We’ve spent so much time introducing you to the children you’re saving that we never introduced you to the people who are doing the saving!

But that’s about to change, starting today.

This is the first of a series where we’ll introduce you to the fantastic volunteer doctors and nurses who are saving lives and helping us eradicate The Backlog. And—since they come on most missions—we’re starting with the respiratory therapist, or ‘RT’ for short.

So I’ve asked Rachel Gulden, a friend and registered respiratory therapist, to share a bit about her work and what it entails:

After surgery, kids require a lot of care, and their breathing can be difficult to monitor and maintain. Rachel explains:

So there’s a quick introduction to the Respiratory Therapist, an important member of the medical teams taking care of these children. Considering you’re helping us provide plane tickets to these teams, we think it’s important for you to know what kind of care you’re providing.

Come back for our upcoming Remedy Mission XIV (that’s 14 for you non-Romans) and we’ll introduce you to another team member and their role. Thanks for reading!

Our Partners:

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

Celebrate With Us—Remedy Mission XII Was A Success!

October 14, 2012 by matt · Leave a Comment 

Double fist-pump!

It’s time to join baby Fatima (pictured above) in celebrating the successful end of Remedy Mission XII! Thanks to you guys, Fatima and 13 other children received heart operations.

Iraqi surgical residents like Dr. Husam (pictured below, on the left) also logged extensive training hours and even got to operate individually alongside our partner surgeon for the first time. When I asked Dr. Husam about the experience later that day, he was beaming—he was ecstatic that he’d been given the opportunity!

These are the gifts you’ve helped us give to Iraqi families and aspiring doctors—thank you. All this training and operating is a step in the best direction possible: an independent, fully-functioning pediatric heart center in the city of Najaf.

But just because Remedy Mission XII is over doesn’t mean the stories are stopping.

You’ve invested too much into these missions for us to just give you two weeks of concentrated stories (though we do that in real-time as well!). So stay tuned, we’ve got folders full of photos for you, and we’ve even got another video or two coming.

As always, thank you for giving toward helping these children. We go back to Najaf in a few weeks—what better way to keep keep helping children than by donating toward our Remedy Mission fund HERE?

More to come…

Our Partners:

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

VIDEO: Update From The Operating Room— “Thank You!”

September 26, 2012 by matt · Leave a Comment 

This is our final O.R. update for Remedy Mission XI in Najaf, and we can’t think of a better time to thank you for the lives you’ve helped save than right now! You made this a happy ending.

You gave money that bought plane tickets that led to training that saved lives and led to Iraqi doctors saying things like “I never imagined I would be learning to operate like this!”

So thank you!

Also, please allow us to use this space to thank our partners at Living Light International for their role in setting up this mission with the Ministry of Health and the provincial government of Najaf. We could not do this without their expertise and their devotion to the cause and their belief in the vision toward which we are moving. Also, we are grateful to the International Children’s Heart Foundation and their cadre of staff and volunteers from Memphis to Melbourne. None of the staff at PLC have any of the medical skills necessary to save these sweet children. Our hopes and our vision for the future of Iraq would be dead in the water without Dr. Novick and ICHF.

In the video, we also share a bit about Hussain and his progress as well as info on our fast-approaching Remedy Mission XII, where we’ll introduce you to even more amazing children in need of lifesaving heart surgery. You can donate below to partner with us further, and keep reading here on the blog—the best is yet to come.

Help us go back to Najaf to save more lives by donating below!

Our Partners:

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

A Peek Inside The O.R.—Watch Hussain’s Six Hour Surgery In Two Minutes!

September 23, 2012 by matt · Leave a Comment 

Have you ever wondered what a surgery actually looks like? Have you ever wanted to peek into the O.R. to see what it takes to save a child’s life?

Considering how much you’ve donated, started your own fundraisers, and cheered kids on over the past few years, I’d say you deserve a glimpse of all that you’re making possible.

So I got permission from the local surgeons to set my camera up outside the operating theatre—for 7 hours! Little Hussain’s operation had a few twists and turns, but sitting outside that door watching it all unfold was well worth it, and now you can do the same. Click the video above (or click here) to watch the lifesaving surgery you gave to Hussain!

###

Would you like to make more surgeries like this possible? We’re going back to this same operating room in just a couple weeks, and we need your help saving more lives. Click here to donate directly, or go start your own fundraiser here—we love doing this alongside you!

Our Partners:

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

A Word Of Thanks To Our Partners!

September 21, 2012 by matt · Leave a Comment 

Missions like this wouldn’t be possible without our excellent partners: Living Light International, The International Children’s Heart Foundation, and the local doctors and director of health in Najaf.

Thanks to them, 14 children received heart operations during Remedy Mission XI, and thousands of hours of hands-on training were provided to local professionals. Find out more about their work online here:

International Children’s Heart Foundation: Website | Twitter | Facebook

Living Light Internationall: Facebook | Twitter

And get ready for our next mission with these great people—Remedy Mission XII is coming soon!

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

VIDEO: Our Third Update From The Operating Room In Najaf

September 16, 2012 by matt · Leave a Comment 

We’re back in Najaf for Remedy Mission XI, and the surgeries are well underway! Push play to hear our surgery count so far and how the local doctors are reacting to these fantastic training opportunities.

Keep watching to see updates of Hussain—we hear he’s in the hospital! This is the third of several operating room updates that we’ll be sending you, so keep watching and visit our Facebook page to see more photos from the hospital.

Our Partners:

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

A Pre-Op Photo Shoot With The Cutest Baby Ever!

September 16, 2012 by matt · Leave a Comment 

Sooooo remember a couple days ago when I said I’d met the cutest child ever? I may have been wrong…

Our Partners:

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

“Thank You For Save Her, Sir!” Proud Parents Bring Back A Healthy, Adorable Sema

September 13, 2012 by matt · Leave a Comment 

Every mission I could swear I’d met the cutest child on the planet, they’re always one-upping each other. But today this little jewel was carried into the hospital break room, and I’m quite sure she takes the cake. And the crazy thing is, I’d already met her and didn’t realize it!

Her name is Sema (pronounced seh-mah), and she was the first arterial switch operation to be performed in Najaf last February. She was actually one of the first operations from Remedy Mission IX, and now she’s back for a post-op screening (just to make sure everything’s working alright).

Since our last encounter, Sema has learned how to smile, clap, eat on her own, and her skin is now a nice, life-like hue—as opposed to the blueberry tone she had before. Her parents were ecstatic and insisted that I take photos—a dream come true for any photographer!

After Sema had thoroughly won all of us over, her father grabbed Dr. Novick’s hand and, with a cracking voice and moist eyes, said, “Thank you for save her, sir!” His joy was a great reminder of why we do what we do, and it was a great reminder of how desperate these parents are. As you can imagine, the entire team was encouraged by their visit.

But Sema and her sweet smile wouldn’t be with us today if it weren’t for you—you gave money to make sure these Remedy Missions happen, and Sema is a testament to that. Would you consider giving again? Click here to donate and to help us save more children like Sema—we can’t do this without you!

As Communication Director, Matt Willingham spends most of his time trying to get the word out on PLC's work in Iraq. On the side, he likes reading stories, devouring the great food his wife cooks up, and DSLR camera work. He's also mildly obsessed with Twitter: @mehtin.

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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 children in pursuit of peace between communities at odds. We offer the untold thousands of Iraqi kids 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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