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


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 Q: What are you trying to accomplish?

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

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

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

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

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

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

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

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

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

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

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

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

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

 Q: Any other costs?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Jeremy Courtney Founder, Executive Director Twitter: @Jeremy_Courtney

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

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

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:

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.

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.

Hussain: The Good News & The Sad

May 8, 2012 by matt · Leave a Comment 

Friends, Hussain’s surgery has been post-poned. That’s the sad news. Our lead surgeon’s foot is injured, and he needs surgery and rest. As discouraging as this is, it’s for the best because it will allow our surgeon to fully heal and then provide Hussain with even better treatment.

Now for the good news: Our goal for Hussain is 75% complete—we just lack $1,000!

Will you help Hussain make it to the finish line by donating toward his surgery? If just a handful of you give $10 and $15 gifts, he’ll be there. And anything you give beyond that goal will go toward helping other children at the next Remedy Mission.

It’s discouraging that something as small as a foot injury can keep Hussain and his friends from surgery, but we believe Hussain is worth the wait. Please continue to pray for Hussain and to wait for his healing with us.

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.

Hussain, or John Wayne?—See Him Play Cowboy With His Doctors!

May 1, 2012 by matt · Leave a Comment 

Have you picked up on how much Hussain enjoys playing around yet? This was a short video clip from the first time I met this boy.

To track his progress and to interact with Hussain online, check out Hussain’s party page. You can leave him a note and we’ll show it to him once we’re in the hospital! Make a short video, craft a poster, or get the kids together to color Hussain with a new heart. Click here to connect with him now!

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.

A Glance Back, A Long Look Forward

April 19, 2012 by matt · Leave a Comment 

I’m sure this has never happened to you, but today I got distracted at work…

I blame the internet (read: Twitter) for being so interesting. But at least it was a semi-productive kind of distracted; I started reading back through some of the very first posts on this blog, written by Jeremy way back in the day.

This was back when we still emphasized our Buy Shoes. Save Lives. program, and Jeremy ended a few of the emails with quirky phrases like “shod thyself” and signed off with some pretty epic monikers like “the rad-ifier” (someone who makes things rad, obviously) and “the wristbandits,” just to name a couple.

But all this rabbit-trailing was a great reminder of PLC’s history and what you have made possible! Some of you have faithfully read this blog for years. You’ve been with us through serious tragedy, and sky-high elation. You stuck with us when we failed (and wrote about it in-detail) and when we transitioned to our current Remedy Mission model.

You rooted us on back when this was all just a big, beautiful mess-of-an-idea. You believed in us, and I hope you know how grateful we are for it.

PLC turned 4 years-old last February, and that quick look back at our history reminded me how much further we have to go. By the end of the year we’ll be developing heart centers in 5 cities across the country—great news, right!? But the key word there is ‘developing,’ because these centers will likely take 5-8 years before they’re fully independent and self-sustaining.

So we need you to stick with us, to keep reading, and to remember that this won’t happen without you. Countless thousands of children are still waiting, and countless thousands will be saved if we can just keep moving and looking forward together.

With you to the end,

The Rad-ifier

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.

Saddam, Sanctions, & Surgery—Another Chat with Hussain’s Dad

April 17, 2012 by matt · Leave a Comment 

A couple weeks ago we had you listen in on a phone conversation with Hussain’s dad. He shared about their family’s long search for a surgery and how eager Hussain is to get a new heart.

I spent several afternoons playing with Hussain while he was waiting to have his diagnostic tests run, and let me tell you, this kid loves to play. Hussain was easily the most fun person to be around at the hospital, and all the time we spent together made me even more excited to stay in touch with him and his family while they wait for surgery. Here are some of the recent questions we asked Hussain’s dad:

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We’re just a few weeks away from Remedy Mission X, and we’re hoping to provide Hussain with a long-awaited surgery—check out his page HERE to learn how you can help. We’ll also be sharing his progress on our recently-updated Facebook page.

Stick with us…more to come.

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.

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.

We just got off the phone with Hussain’s dad!

April 5, 2012 by matt · Leave a Comment 

###

You can help us answer that last question. We hope to give Hussain his operation at the end of this month, but we need your help bringing the doctors back. Visit Hussain’s page to give toward his surgery and to help give him a new heart!

P.S.—We’re half way toward reaching our financial goal for Hussain! Help us ensure surgery for him by donating below.

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.

Three Ways Our Vision Was Too Small—And How It Has Matured (Part 2 of 2)

April 3, 2012 by Jeremy · Leave a Comment 

In my previous post I confessed three ways we got our vision wrong in the early days and touched upon how we’ve seen our vision mature along the way. Here I want to actually tell you what our vision is today. It is not perfect, but neither is it final. We will continue to learn and allow ourselves to be shaped.

We envision a future in which all Iraqi children have access to the lifesaving heart surgeries they need within two hours of home.

There will still be an old backlog for a decade to come. And there are many obstacles to overcome that are beyond our immediate realm of influence (a nationwide dearth of anesthesiologists and nurses, for example).

It is our mission to eradicate the backlog, only now the ”why” behind the “what” is more nuanced and mature. The backlog will be eradicated by the hands of the doctors and the nurses we train. The country probably needs 10 heart centers performing 500-1,000 surgeries per year. We hope to be involved in saving lives and training locals in as many of those sites as possible so that every child with a heart defect has access to the lifesaving surgery they need within a two hour drive of their home.

Why so many centers? Why not settle for all children flying to Baghdad for the surgeries they need? Because the backlog is too great and the long-term forecast is too dim for one or two expert hospitals alone. The nation requires regional solutions. A single expert center in Baghdad will not suffice.

Today we have active programs in Nasiriyah and Najaf—sites that collectively serve a population roughly the size of Chicago, Los Angeles, Philadelphia and Houston. Before the end of the year we hope to begin healing children in Fallujah, Basra and Dohuk as well.

And this is not just our vision. This vision developed in conjunction with Iraqi doctors, governors and health care directors from across the country. At present six additional cities across the country have requested the assistance of our Remedy Mission teams. And the Iraqi Ministry of Health is extremely invested financially in the success of this collective vision.

For all the questions that remain, we let this collective vision guide us: a future Iraq in which all children have access to the lifesaving heart surgeries they need within a two hour drive of their home.

We will need your help realizing this vision. It won’t be easy to establish heart centers within two hours of every population center in the country. But it will unmake violence and remake the worlds of thousands of Iraqis whom we love and live to serve.

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If you have any questions or comments regarding the development of vision or anything I’ve said in this or in my previous post on vision, please email me at your convenience. I would love to hear from you.

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!

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.

Three Ways Our Vision Was Too Small—And How It Has Matured (Part 1 of 2)

March 27, 2012 by Jeremy · Leave a Comment 

A few weeks ago we ran a short series on cultivating vision… these posts were not perfunctory. They were, in fact, my own practice of establishing the Preemptive Love Coalition with my wife, Jessica, and Cody Fisher.

In our earliest days we said our mission as an organization was to “eradicate the backlog of children in Iraq waiting in line for lifesaving heart surgery.” But the best visions and missions are dynamic, almost alive; they mature. And we are excited to bring you along in our vision as it has matured in recent months.

We have learned a lot more about this field in which we work than we knew when we started out. Additionally, the country and the individual regions of Iraq have changed drastically since we arrived. There were numerous occasions in which we said, “Does our mission still fit?”

Below are three ways in which we realized our vision was “off”:

#1: The Math—How We Saw the Problem

The math does not add up for us to “eradicate the backlog” on our own. Indeed, our vision in 2007 had largely to do with 700 known children in one Kurdish province who were in need of surgery; we now know about thousands waiting in nearly every one of Iraq’s 18 provinces. And we estimate 6,000-11,000 new children annually are born in Iraq with congenital heart defects.

How we see the problem determines how we shape our vision for the future. A problem with 700 localized constituents might warrant one vision. A nationwide problem with perpetuity and tens of thousands of constituents likely calls for a different vision altogether.

#2: The Method—How We Addressed the Problem

Local doctors set the stage by telling families there were no solutions in Iraq for their children who needed heart surgery. That was true. So families, local development experts, political figures and doctors all asked us to assist by sending children outside the country. 

On the one hand, we met a real need. On the other hand, we lacked imagination and delayed the development of long-term local solutions.

 It took us almost three years to imagine and implement our Remedy Missions—a far better use of resources to create local-led solutions for this local problem.

#3: The Message—How We Talked About Solutions

Because we began by exporting the Iraqi congenital heart disease problem to others countries, we largely failed to factor local healthcare experts into our vision for the future. We worked with one local cardiologist, but when we talked about our solution for “eradicating the backlog”, we largely talked about you—the donor—and how you were the solution to all the ills facing these dear families. 

We set up web pages and called on you to save the lives of children like Aras, Shad and Nivar.

 We still call on you to help save lives—but we feel much more keenly today that our message has matured, because our methods are finally dependent on locals. And that has happened because both statistics and ethics compelled us to see the problem differently.

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In part two of this post we’ll actually articulate our vision as it has matured. Come back next Tuesday to read more. In the mean-time, why don’t you contact me with your own thoughts and stories about vision? Please email me at your convenience. I would love to hear from you.

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.

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OUR BLOGGERS

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

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

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