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)

Iraq Sees Its Second Arterial Switch—Ever!

January 14, 2012 by Cody · Leave a Comment 

Baby Ridha was born just 19 days ago. She may not be old enough to keep up with The Fantastic Five, but she was born at the perfect time for the surgeons to save her life. By the time Remedy arrived, Ridha’s heart was at the perfect developmental stage to be fixed, making her the 2nd (and the youngest!) baby to ever receive an arterial switch in Iraq!

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

Little Amjed is The First One in and Out of Surgery!

January 12, 2012 by Cody · Leave a Comment 

Amjed is the first child to breeze through his heart operation and begin his recovery in the ICU today! Right now he has the entire ICU to himself but it’s about to get crowded fast. More are on their way!

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

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

July 29, 2011 by matt · 2 Comments 

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

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

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

As PLC's Press Secretary, Matt Willingham is bent on leveraging words and media to connect hearts and minds to Iraqi children in need. On the side, he likes reading old books, devouring the great food his wife cooks up and dabbling in DSLR video work. He's also mildly obsessed with Twitter: @mehtin.

Noor’s Heading Into Surgery!

July 4, 2011 by Cody · Leave a Comment 

Noor’s wait is over!

She’s made it into the operating room and the doctors are hard at work making sure that they send Noor away with a strong and healthy heart!

If they’re able to accomplish all they hope to accomplish with Noor, it will be the 9th lifesaving heart surgery this trip.

Thanks for making this possible! More news to come…

Our Partners:

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

3 Reasons You Can Give Someone To Show Them Iraq Is Changing For The Better

June 26, 2011 by Cody · 1 Comment 

Yesterday on the drive to southern Iraq we ran over a pothole. Actually, we ran over several potholes.

The biggest pothole of the day – and the same one that made the loudest noise as our van clung to its parts – was the same one that caused my Iraqi friend next to me to groan and say, “I just want to see change. I want to see something different now that the war’s over. Where are the new roads? Where are the signs that Iraq is changing?”

The next pothole we hit launched us both into a conversation attempting to answer that question. It kept us busy for most of the drive, but we kept coming back to the same 3 immediate signs that Iraq is changing for the better.

Sign #1: Right now, families are traveling from all over southern Iraq to come to this Remedy Mission. Before, families were lining up to leave the country trying to find the doctors that could save their children from their heart defects. Today, families are lining up outside a hospital in southern Iraq, waiting for their child’s chance at a lifesaving heart surgery. For the first time, families don’t need to leave the country to find the cure.

Sign #2: This week, a Sunni family will hand their child over to a Shiite doctor to be saved. In 2007, at the height of the violence in Iraq between Sunni and Shiites, this would have been unheard of. Now, the disease that’s threatening their children is bringing them together!

Sign #3: The notorious “brain drain” that happened when 20,000 of the 34,000 registered doctors in Iraq fled during the war is being reversed. During our last Remedy Mission in northern Iraq we met one of the doctors who had returned. Today we’re not only seeing doctors return, but – thanks to Remedy Missions – the doctors who never left are being equipped and trained, too. Their training is changing the tide of healthcare in Iraq.

So, the next time you hear someone looking for a reason to believe Iraq is changing for the better, start by giving them these 3.

Or better yet, show them the above photo of Rayed smiling before he received his lifesaving heart surgery during Remedy Mission V. Then tell them to stay tuned because Remedy Mission VI is already underway here in southern Iraq!

Our Partners:

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

We’re About To Launch Our Fourth Remedy Mission In Iraq !

February 27, 2011 by Cody · 3 Comments 

The ICHF medical team and children who are hoping to receive life-saving heart surgeries over the next two weeks are all making their way to the local hospital to launch our FOURTH Remedy Mission in Iraq!

While Iraq is all over the headlines today for protests and rage directed towards the lack of jobs, utilities, and corruption – there are thousands of families in northern Iraq who are still fighting for their children’s lives and for better healthcare for those who were born with congenital heart disease.

Instead of taking to the streets these next two weeks, our “protest” will take place in the quiet operating room where hearts will be mended and doctors and nurses will be receiving training and education.

Instead of fiery speeches on bullhorns, nurses in the ICU will receive careful instructions on how to properly take care of children after open heart surgery.

Instead of holding signs we will be holding the hands of children in the hospital ward as they patiently wait for surgery.

Instead of only hoping for change, we will see children’s hearts changed overnight!

Remedy Missions continue to gain momentum throughout Iraq, thanks to YOU!

Stay tuned! Another one starts NOW!

If you’re on Twitter this week be sure to use the #RemedyMission hashtag to describe all the good news coming out of Iraq this week via @preemptivelove.



With help from our friends:

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

See One. Do One. Teach One. Remedy Mission Trains Iraqi Heart Doctors and Nurses for the Future of the Children and their Country

February 23, 2011 by Jeremy · Leave a Comment 

Push play above for a peek into what it means for our volunteers to be here training local Iraqi heart doctors and nurses. After you’ve viewed it, please “SHARE” below with Facebook, Twitter, StumbleUpon, Digg, etc.

If you’re on Twitter this week be sure to use the #RemedyMission hashtag to describe all the good news coming out of Iraq this week via @preemptivelove.

Our Partners

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

Alawi Receives His Much Needed Heart Surgery!

February 21, 2011 by Cody · Leave a Comment 

This morning Alawi got the heart surgery we’ve all been waiting for!

Local doctors and nurses – alongside the ICHF team – took a minimalistic approach to his repair, seeking to do as little “trauma” to his heart as possible. Unfortunately, after surgery, it seemed the minimalist approach wasn’t holding as well as they hoped. They decided to perform an even more robust correction that would make Alawi even stronger than he already was.

So Alawi went yet again into the operating room just as bravely as he went into his first operation.

Alawi’s a reminder of what we’re committed to – we will do whatever it takes to make each child and each Iraqi doctor and nurse into the healthiest child and most-skilled doctor or nurse they can be.

Hoping for the best still never makes it easy to watch a child go in for surgery.

We could not do this without you! You are our heroes and you inspire us to keep going so much! Stay tuned to get the latest update on Alawi from the ICU via our Facebook Page!

Our Partners

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

10 Things You Need To Know You’re A Part Of When You Support Remedy

February 20, 2011 by Cody · Leave a Comment 

Did you know that each Remedy provides over 7,000 hours of hands on training and education for local Iraqi doctors and nurses during each two week mission?

Did you know that each medical team Remedy brings in is composed of 15 medical professionals from some of the world’s top hospitals?

Did you know that each medical team member Remedy brings in has one goal, and that’s to teach and inspire locals?

Did you know that Remedy literally trains 24 hours a day, 7 days a week from the moment it begins to the moment it ends?

Did you know that most medical team members Remedy brings in are giving up their only 2 weeks of vacation time to come and be involved in investing in the future of Iraq?

Did you know that Remedy is one of the only outside programs that is investing in the health care in Iraq by training locals where they live rather than just extracting children and operating on them overseas?

Did you know that Remedy is proving itself to be one of the most effective tools in inspiring and encouraging local Iraqi medical teams while tearing down walls of prejudices and misunderstanding between the East and the West?

Did you know that each Remedy gives local surgeons the skills and knowledge to perform surgeries they never knew how to perform before?

Did you know that in the midst of thousands of hours of training each Remedy, over twenty children are given life-saving heart surgeries each trip?

Did you know that’s what you get to be a part of each time you support Remedy?

We hope so!

Because Remedy wouldn’t be gaining momentum all across Iraq if it wasn’t for you!

Our Partners

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

Meet Ali. He Finally Got His Lifesaving Surgery on Our Second Trip to Southern Iraq

February 17, 2011 by Jeremy · Leave a Comment 

Ali gets his surgery as the first child during our February 2011 Remedy Mission to southern Iraq.

An interview with Cody Fisher about his first encounter with Ali and the journey to where he is today.

Push play above to meet little Ali….

With you,

If you’re on Twitter this week be sure to use the #RemedyMission hashtag to describe all the good news coming out of Iraq this week via @preemptivelove.

Our Partners

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

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Preemptive Love Coalition provides lifesaving heart surgeries for Iraqi kids in pursuit of peace between communities at odds. We offer the 30,000 Iraqi children suffering from life-threatening heart defects a chance at the surgery they need to save their lives. With our world-class international surgical partners we create long-term solutions by training local Iraqi doctors and nurses so they can sustainably save lives without our help.

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