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)

Photographer Farewell

November 22, 2011 by matt · Leave a Comment 

Friends, today is a sad day. After 7 months of working together, we’re saying goodbye to our photographer, Lydia O’Neil. She’s headed home to finish her last semester at the Corcoran College of Art + Design.

If you’ve spent time exploring any of our online real estate, you’ve probably admired her photos. We’ve received countless messages from people saying how much they enjoyed her Daily Squares on Facebook, her photos of children, and her work on our Flickr stream.

So, while we’re sad to see her go, we’re excited to see what her future holds. If you’ve admired her work, head over to her personal website and tell her so. I’m sure she’d appreciate the encouragement! You can also follow her on twitter here.

Goodbye, friend! We miss you already and hope, insh’allah, to work with you again soon!

Much love,

The PLC Staff

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.

5 Ways to Destroy a Nation’s Healthcare System

September 9, 2011 by Ryan · 4 Comments 

Whenever someone hears about our kids or reads about our work they almost always arrive at the same question: “How did Iraq get this way?” “What caused this?” “Who’s to blame?”

Well, after 4 years of working throughout this country we believe we can provide you with a concise answer to that incredibly complex question. This isn’t about guilting anyone or pointing the finger (there’s already too much of that going around), but it is a hard look at the answer to your question.

Based on Iraq’s history, here are 5 ways to destroy a nation’s healthcare system:

1. Limit a country’s ability to operate politically and economically
In 1990 the UN Security Council passed Resolution 661, which imposed broad, restrictive regulations upon Iraq. In a nutshell, these regulations stipulated that no country in the UN could import or receive any goods from the country.

Unfortunately, the sanctions did more than impede the political and military action of the Iraqi aggressors. The Iraqi economy, that had been so dependent upon oil exports and foreign trade, crashed as a direct result of the Resolution 661.

In 1989 Iraq’s gross domestic profit was over $66 billion. Just seven years later it was estimated as being $10.8 billion. In 1989, annual income per household was $3,510, and by 1996 had fallen to less than $500. Before the sanctions, 93% of the population had ready access to healthcare institutions, which were staffed primarily by physicians who had been trained in Europe or the United States.

This economic collapse primed the country for the health crisis it is in today, a health crisis that has lead to the death of inestimable millions over the last two decades.

2. Slash governmental healthcare funding
In the 1990′s Saddam Hussein cut spending on healthcare by 90%. Continued education, supplies of necessary equipment, and valuable public health programs all suffered without adequate funding research.

Without funding and governmental support, the healthcare system deteriorated.

3. Reduce the number of medical professionals in the country
In some areas, insurgents made it a practice of targeting medical professionals. Although many doctors were not individually targeted, they were still in danger. Ambulances were frequently robbed of their medical supplies, and it was not uncommon for gunmen to enter hospitals and force doctors to care for their injured family members or comrades.

Another blow was dealt to the stability of Iraq’s healthcare when many doctors and nurses, who were lucky enough to escape death, fled the country in a mass exodus, further damaging the quality of the Iraqi healthcare system.

The murder and exodus of Iraqi healthcare professionals is tragic. It has left many families broken and many patients without the care that they need. But the negative effects extend beyond their families and the patients they left behind. Without their mentor-ship, expertise, and knowledge, generations of students from universities and teaching hospitals will continue to have insubstantial educations.

4. Destroy physical healthcare infrastructure
In 2003 American and Coalition forces destroyed two primary public health laboratories and an estimated 12% of hospitals. While speaking about the state of the nation’s healthcare infrastructure, former Minister of Health of Iraq, Khudair Abbas, explained that of the remaining primary care centers, “15% have been looted. Even though 80% remain intact, 40% need extensive repairs…13% do not have clean water and one third are staffed primarily by paramedics rather than physicians”.

During the Gulf War, American and coalition forces destroyed key elements of Iraq’s infrastructure. “Bridges, communications, electricity supplies, water and sewage systems, weapons factories, healthcare facilities, administrative centers, warehouses” and homes were destroyed. While this may have been a strategy aimed at ceasing Iraq’s ability to make war, this strategy did far more than defeat the Iraqi military.

5. Overburden the healthcare system by creating too many patients

The above contributing factors deal primarily with political, structural, organizational, or educational deficits. Ultimately, however, it is the population of patients that compose the largest component of any healthcare system. And, regrettably, there is a vast population of patients in Iraq.

The demolition of water and sewage treatment plants lead to outbreaks of typhoid and cholera. In 1989, there were no cases of cholera per 100,000 people; just 5 years later there were 1,344 cases per 100,000 people.

According to studies, by 1996 31% of children under five were chronically malnourished. Just a year later, there were a million children under the age of five who were malnourished, and a year after that 70% of women were suffering from anemia. Another study, consistent with the information on malnutrition, found widespread, chronic stunting in school children as an indication of long-term malnutrition.

Poverty’s wide-spread negatively affects the livelihood of the Iraqi people. Low socioeconomic status is associated with lower levels of education, poorer nutritional intake, and higher risk of congenital heart defects.

Research shows that poor diet contributes to far more negative effects than weight loss, anemia, nutritional deficiency, and compromised immune system. Without the funds to afford healthier food, mothers with higher intake of saturated fats and lower intake of nicotinamide (vitamin B3) have increased risk of giving birth to children with congenital heart defects. 5, 8 Furthermore, low dietary intake levels of folic acid (vitamin B9) around the time of conception have been linked to higher risk of neural tube disorders.

But nutrition and education are not the sole arbiters of death and ill health. Many parts of the country still suffer from the chemical and biological attacks perpetrated by Saddam Hussein. Not only are individuals suffering from primary exposure, but research supports that children of those who were exposed suffer secondary effects in the form of birth defects.

The list of health problems and their contributing factors continues ad nauseam, and the patient-load continues to overwhelm doctors.

The evidence shows that the state of Iraq’s healthcare system has been nearly two decades in the making. The downward spiral began with sanctions in the 1990’s by making the nation more susceptible to economic collapse. It continued with a multitude of factors including military action by the US and Coalition forces, violence wrought by religious extremists, and a vast backlog of patients.

—–

The question remains, is it too late for Iraqis to rebuild their healthcare system?

Is Iraq too far gone?

Of course not! The restoration of Iraq’s medical infrastructure is happening now!

This November 5th will be our biggest surgical mission yet–lives will be saved, doctors will be trained and Iraq will be one big step closer to restoring what was broken!

Ryan Rosenberry is spending his summer as a PLC intern (’11) compiling Remedy reports and researching CHD and prenatal care. When not citing sources, this pre-med California native can be found playing the guitar (or piano), partaking in a game of Ultimate Frisbee, or doodling his favorite animal: the pink sea slug.

Death Will Never Conquer

March 4, 2011 by Jeremy · 5 Comments 

Yahya passed away early this morning after an all-night surgery. It was a surprise to everyone. When he was admitted to the ICU there seemed to be plenty of confidence that he would be just fine. But within just 30 minutes of admission his heart gave out and all efforts to revive him failed.

I still remember the first time I was introduced to Yahya. It was over a year ago. His uncle called my cell phone and said, “I’m at your office, I need to talk to you about a sick kid.”

It was after hours and I was already at home. But I could hear the urgency in his voice so I invited him to my home for tea. He arrived and made an impassioned plea for Yahya – his brother’s son. I was leery of helping Yahya after reading his reports – we had seen some children with complex heart defects like him die abroad and I couldn’t stand to put a family through that drama again. I did my best to avoid commitment and send Yahya’s uncle into the night without any solid hope for his nephew.

The following weeks were filled with phone calls and followup from the family, “Please help our boy!”

Finally, I met Yahya’s mom and dad and the little cutie himself. As they sat in my office they pled with humble urgency. They weren’t forceful. They weren’t rude. But they applied enough pressure on me that I couldn’t say “no” any longer. They made it abundantly clear that they understood the risk of his surgery and that they wanted it badly enough to endure whatever might come.

One of our core values as an organization is that we give “hope to the hopeless.” What that means is that we try to balance our impulse to be “last chance” people with our instinct to be “long-term” people. We held back on Yahya, wondering if it would give him long-term viability. But we ultimately dove in with Yahya’s family because we were their last chance. No one else would take on the risk.

We solidified this core value in November 2009 when we asked you what to do about a little boy named Ramyar. We asked you if you wanted us to apply your money in a high risk surgery or save it for a “sure thing.” You overwhelming said, “We want this Coalition to be about hope for the hopeless.”

We haven’t looked back since. We are the Last Chancers.

Still, committing to Yahya was full of complications. His surgery in Turkey was canceled due to an unavailability of an expensive assistant device. In fact, there was even discussion as to whether or not he should be included in our current Remedy Mission. Ultimately, we let the family themselves decide.

Our local cardiologist, along with our American surgeon, explained the risks of surgery, the option of waiting, etc. etc. Yahya’s dad was given a 50/50 chance of survival for little Yahya. Understandably, they wanted to give it a try. They couldn’t stand the risk of feeling like they had an opportunity to try and let it slip through their hands.

What would you have done? I have two kids – 5 and 3 years old. I have no idea what I would have done.

During Yahya’s surgery our Family Services Director, Jessica, sat down in the ward with all the parents whose kids were either in surgery or in critical condition in the ICU – those families whose kids were not “out of the woods” yet. As they asked questions about our organization and how long we’ve been working here, she recounted for them our past of taking children outside the country to significantly nicer hospitals than this Iraqi version in which we currently work. She told them about excellent American-trained Turkish doctors and fancy, pristine protocols abroad. Without fail, every family was so grateful for the chance to receive surgery at home. Let the Turks have their pristine hospital. “What if our child were to die abroad?” That would be a burden far too great to bear.

You gave Yahya’s family a chance that no one else would have. He had been rejected by every other opportunity out there. They are grateful to you. They will rest knowing they gave it their all for their only child.

And this is what we find almost universally – parents who just want a chance. And that’s what Remedy Missions are all about. We could continue to export kids to world class facilities, but who would invest in the future? We could continue to select the easiest children that almost never die, but does that make us any less culpable for the kids we pretend aren’t knocking on our door?

Was this a wasted opportunity? Did we waste the $670 that it cost us to provide Yahya surgery?

I used to feel that way when a child died in Turkey or Jordan or Jordan. I don’t feel that way anymore. Yahya’s death – though a terrible loss – was still an opportunity for local doctors to learn an innovative technique that they will be able to apply in future situations. His death was almost certainly unrelated to the particular tactic used in attempting to heal his heart. Educational gains always have significant costs. Before we only had the “we gave this child a chance” platitude. It’s not untrue. But local learning is an equally deep reason why your gift for Yahya made a difference.

Thank you for your willingness to stick with us through life and death. The gains that are needed here will not be made without significant risk and vision. We deeply appreciate your demand that we be the people of the last chance. I think it’s easier to sleep knowing we tried, than knowing we played it safe just so we could publish numbers and blog posts that seem more palatable.

With you,

Jeremy Courtney

Executive Director

email: http://scr.im/jcourt

+1 (806) 853-9131

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’re Already Plotting Our Way Back To Hamma

February 24, 2011 by Cody · 1 Comment 

We had to say goodbye to baby Hamma and his mother.

We didn’t want to.

We didn’t want to say goodbye because his big brown eyes and his mother’s smile drew us in from the moment we met them.

Another reason we didn’t want to say goodbye is because Hamma never received the surgery he needed to patch the hole in his heart.

He was scheduled to receive surgery but was delayed three different times.On the fourth time, the Intensive Care Unit had no more beds open for children and by the time a bed opened up, there wasn’t enough time to operate on Hamma.

Remedy was already coming to a close.

So after waiting ten days in the hospital for surgery, Hamma and his mother had to go home without a remedy.

It’s eerie to walk through the hospital ward now and see entire rooms that were packed with families, now empty and vacant because once we leave, the Remedy Mission comes to an end.

That breaks our hearts.

As long as there are children with heart disease, they should be in the hospital getting treated. In southern Iraq, it doesn’t work that way because the doctors and nurses don’t have the skills they need to take care of all the children with heart disease.

One day they will. That’s what Remedy Missions are all about.

We told Hamma’s mother that we would be back in May and that Hamma is one of the first babies that the doctors want to operate on.

So we’re standing up for Hamma!

When you order our new tank, 100% of the profit goes toward bringing Remedy back to Hamma! All we have to do is sell 59 to give Hamma his life-saving surgery and to take one step closer toward not just bringing Remedy back to southern Iraq, but to LEAVING it there!

Some tanks blow holes in stuff. This tank patches the hole in a heart. Stand up for Hamma!

Order NOW by clicking HERE!

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

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.

The Good & The Bad: A Report On One of Our Remedy Kids Who Did Not Make It Through

September 7, 2010 by Jeremy · Leave a Comment 

Video by Jon Vidar

We strive for transparency here; not marketing or public relations fluff. At the beginning of our Remedy Mission we chose a few children to feature on the website. At that time, we did not know which ones would survive and which ones would die; who would have an easy course and who would have a most difficult course. We chose them for reasons of timing, dramatic tension, and relational connectivity.

One of the families that was NOT chosen for feature, was actually concurrently featured by a photographer friend that we hired for some of the other work on Remedy Day #1. Jon Vidar had been out to meet Samal and her family weeks before Remedy Mission formally began. Jon was eager to see Samal get the surgery she needed. When he began her story for his personal project, we all had assumed and hoped that she would be one of the ones who benefited greatly from the surgery.

Unfortunately, it didn’t work out that way. Push play above to watch Jon’s excellent piece above to learn more about the situation in Iraq, our Remedy Mission solution, and Samal’s story in particular.

The one thing the ending slide does not capture with enough nuance is the bitter fact that Samal’s brain probably died before a knife was ever laid to her chest after her oxygen levels crashed to 10% for approximately 12 minutes. In that 12 minutes the O.R. team prepared her for surgery, opened her chest, and put her heart on the bypass machine, but she was without oxygen for far too long before they could intervene; they feared she was brain dead. They proceeded with the surgical correction for her heart and took precautionary measures after surgery to give her the greatest chance at recovery, but Samal never pulled through; she was probably too far gone before the surgery technically began.

There are no words or stories, prayers or personal presence that makes a loss like this more palatable. It’s dark and horrifying for the family; and, to a lesser degree, for those of us who invested a tiny bit of ourselves in Samal and her well-being.

There are no good words to wrap up a post like this… but there are more stories of hope to come.

With you,

Remedy Missions are international pediatric heart surgery teams that we bring to Iraq to to perform lifesaving heart surgeries and develop the infrastructure for the future. If you’re on Twitter this week be sure to use the #Remedy or #RemedyMission hashtag to describe all the good news coming out of Iraq this week via @preemptivelove and @babyheart_org. If you’re on Facebook, “Share” this story with the button below.

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.

HOPE DENIED FOR PARWA

May 17, 2010 by Jessica · Leave a Comment 

This is not a very hopeful blog post, but one that is an everyday reality for many families in Iraq. Today I was sitting with Parwa’s family in their home when we learned she was deemed inoperable last week by an in-country diagnostic procedure. A wonderful team of American doctors came to our city last week and gave free check-ups and catheterizations (a procedure to assess how well the heart is pumping blood) to the children here. That part isn’t the infuriating part. What is infuriating is that this 11-year-old girl missed her chance at surgery; at a “normal” life – and that’s a chance she will never get again.

She should have had surgery 5-6 years ago. Even surgery one year ago may have saved her.

The hole in her heart (VSD) should not have been terminal. VSDs should not be giving death sentences to eleven-year-olds.

From the time I first met Parwa I have loved her. She is an amazing little girl, smiley and full of so much life. Unlike other children with heart problems, she isn’t blue, she goes to school, she plays with her brothers and sisters. If you saw her walking down the street you wouldn’t know that she is dying. And this is part of the problem. No one knew. No one thought to check.

This isn’t a country where most children go to the doctor for wellness checks at 2, 4, 6 months, and every year after that. This isn’t even a country where most children are born in a hospital (and those that are born in hospitals are discharged within hours in many cases without a chance to really assess much more than overt birth defects). Very few provincial doctors know how to check for these problems until it is too late.

In this case, even if they had discovered it at birth, there wouldn’t have been anything the doctors here could have done about it with the medical infrastructure such as it is.

And now it is too late for Parwa. But it is not too late for so many others. Days like today push me forward to walk into more homes and doctors offices and help these little ones who need help now.

Parwa isn’t the only child I saw today. I saw Bawar, a precious two-year-old going to surgery in July, playing outside with his older sister and brother. I also visited Yousif and his ten siblings in their small village house, complete with cows and chickens outside. Bawar and Yousif still have a chance. They are urgent and need surgery quickly. And the best news is that the only thing standing in the way is money. Their parents understand their problems, which led them to appeal to us for help to get to Turkey for their surgeries before it’s too late. Now we are just waiting on the funds.

Can you help?

We plan to send Bawar, Yahya, Leah, Nivar and possibly a few others to surgery on July 18, 2010. All donations will be used to cover their airfare, housing, food, and surgical expenses.

Jessica Courtney lives and loves in Iraq as a co-founder and Family Services Director of the Preemptive Love Coalition. She is also a mother of two children and is married to PLC's Executive Director, Jeremy Courtney. When not absorbed in caring for Iraqi children and sharing life with Iraqi families, she enjoys sewing and scrapbooking.

Leena Returns to Iraq without Surgery

April 27, 2010 by Jeremy · Leave a Comment 

An shot from Leena’s catheter procedure revealing a misdiagnosis and heightened risk for surgery and post-operative course.

It was not an easy decision – and only the second time we’ve ever made it – but a misdiagnosis in Iraq brought us to a fork in the road in Istanbul: (a) take on a high-risk, complicated surgery with a long post-operative course or (b) use the limited resources we have at our disposal to provide a higher impact, less risky surgery for other children waiting in line.

These are not decisions that are easy enough to summarize in a few sentences. These are not “one-for-one” tradeoffs and the complexities can bring otherwise decisive, Type-A people to a complete deadlock. Leena is dear to us, irreplaceable to her family, and precious in the sight of GOD. But there are times when providing surgery for one feels like an act of treason against another. In our case, Leena was a last minute, highly urgent, highly complicated surgery who applied in the midst of our attempts to fulfill previous commitments to less complicated, less risky, more predictable children.

It broke our hearts and we made the decision slowly over 4-5 days through many tears and prayers. But in the end, we sent Leena back to Iraq.

We contacted our friends at Brothers Together and asked them to consider Leena for surgery and found out that her cardiologist and Kurdistan Save the Children in Iraq had already made the appeal as well. We are very grateful to them for filling in for the family at a time when we were unable.

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.

In Tribute to a Fallen Friend

April 19, 2010 by Jeremy · Leave a Comment 

I learned yesterday that the man on the right (above) was assassinated in Baghdad by the Mehdi Militia of Moqtada al-Sadr. The man above is a friend and a partner in our efforts to wage peace in Iraq. In fact, it was his efforts to bridge gaps and stand down oppression that earned him the array of bullets and bombs that finally took his life at the hands of his enemies.

This is not a post to celebrate the Preemptive Love Coalition, me, or anyone other than the countless thousands of brave men and women in Iraq who face down these petulant bullies every day and get virtually no credit; no headline stories; no Facebook pages dedicated to their efforts; no trending topics on Twitter; no books written about their peaceful hearts or comparisons to Mother Teressa or Mohandas Gandhi.

I knew him as Abu Namis or “The father of Namis” – a typical way to be known in Iraq. So it was immediately striking. When I learned of his death, I thought of Namis, now fatherless because his dad worked across the aisle with a vision that far exceeded the atrophied imagination of his opponents.

The photo above is taken from my first meeting with him. The other two men in the picture – who are currently alive & well today الحمد لله – are sheikhs with whom we have worked to help children receive the heart surgeries they’ve needed. All three of these men are Sunni, but like so many un- and under-reported similar groups in Iraq, these men do not bow to the minority who argue for violence between Sunnis and Shi’as.

In that first meeting the man second from the right seemed stand-offish and suspicious. This photo itself seemed more an act of obligation than something born from a genuine desire to mark a memorable meeting after forging the beginnings of a partnership to take children to Turkey in conjunction with their Baghdad-based organization. But when the camera turned off, I put my hand on his shoulder and apologized for the things that had happened to his children, his neighbors, and his countrymen here in Iraq.

We frequently talk about the need to avoid lazy generalizations. All Arabs, Muslims, and Iraqis are not this way or that way. Nor am I America or Christianity. But I can apologize for myself – and I can do it honestly – because the truth is that I didn’t initially have many objections to a lot of the terrible things that happened in Iraq. But that was before “these people” had real names, real stories, and real lives in my eyes.

In an instant, that apology seemed to unlock his heart.An hour has passed inside our poorly lit apartment office and then – for the first time – he took off his glasses. He had seen me for an hour – but I had not been allowed to see him, hiding under a keffiyeh and sun shades. But now I was allowed in. I was still an outsider – but at least an outsider with a heart. And with the glasses off he looked at me and said “Thank you” as tears started coming down.

I’m not trying to be dramatic. But an assassination of a man I knew to be kind and who genuinely desired peace for his people is, in and of itself, dramatic! My main goal here is to honor his memory. To say what the newspapers likely won’t. And to let Abu Namis stand as a representative of so many other unsung Iraqi heros. There are too many to celebrate. And like Abu Namis, many of them pay the price every day.

In the Fall we will begin our first tour of America. We will be talking more about these stories, about Iraqi peacemakers, Muslim peacemakers, and Christians peacemakers; and about how these principles are deeply relevant to your friendships, your marriages, and your engagement with the world around you, and about how you can live a similar life – even when the stakes may not seem as high.

Until then, may GOD do something to amazing and unpredictable to intervene in the current course of events in IRAQ. Peace was GOD’s idea long before it was ours.

Peace from Iraq,

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.

Baby Leena Leaves Iraq for Urgent Surgery in Turkey

April 14, 2010 by Jeremy · Leave a Comment 

It was about mid-morning on Sunday when Leena’s dad came into our office, frantically looking for help for his daughter who was dying before his eyes from her congenital heart defect.

We contacted our partners in Istanbul at the Anadolu Medical Center and they concurred: it might be too late for Leena, now 50 days old, but if there was any remaining chance she should come immediately.

With unprecedented speed we worked with Leena’s father and their extended family to get Leena to surgery. The family and friend network rallied quickly sold their car and rallied with a total of $10,000. Within just a few hours we were able to get our local staff, Leena, and her mother on the very last seats out of Iraq on Tuesday’s flight to Istanbul.

The picture above is Leena’s last moments with her father before leaving him to go back to the village where he is 8 year old Mohammed Star’s elementary school teacher, whom we sent to surgery in November 2009.

Are you looking for a way to get involved? Let us suggest the following three actions: - Sign up for our newsletter to stay apprized of news and deals on stuff you can buy to save lives in Iraq. Name: Email: - Send out a “tweet” or a message about us on Facebook, suggesting your friends check out these dear Iraqi kids. - Give your time or money. Both save lives! For volunteering, send an email to cody@preemptivelove.org. For life-saving tee shirt, shoes, and scarf purchases, head over to our Buy Shoes. Save Lives. store for our 25% OFF SPRING SALE. For donating money, please use the fast and simple form below.

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.

Heran Has Infection Around Her Heart 9 Months After Surgery

February 5, 2010 by Ruth · 1 Comment 

Heran had surgery in May 2009 – the first of two surgeries she’ll need to be considered completely healed. Heran is currently sick with an infection in her heart and Dr. Aso, our local pediatric cardiologist in Iraq, has recommended that she stay in hospital for the course of her antibiotic treatment so that she can be closely monitored.

She was disappointed that she doesn’t have a nice hospital room with her own personal TV like she had during her at Anadolu Medical in Turkey. There aren’t any TV’s at all available for her to watch here so we were pleased that we were able to lend her a mini portable DVD player for her stay as it will be 6-7 weeks which is a long time for anyone and a lifetime for a 7-year-old girl. She was very excited about it!

She’s been very brave so far with so many blood tests and having her cannula site changed every few days. I’ve been visiting her every couple of days for countless games of ‘Uno’! She loves that game!

Heran has been sick a lot these past few months, so we’re hoping that after this infection clears up she will be able to be back at school and that her immune system will become stronger. Visiting is limited to just 2 days a week here so both her and her mother are missing the rest of the family plus she’s missing school a lot too.

We’re thankful for special permission to visit her anytime. So we’ll do our best to keep you posted on her progress.

Ruth Simpson was a Family Advocate for the Preemptive Love Coalition in Iraq (2008-2010) and a certified physio-therapist. Ruth hails from Ireland, though she's slowly losing her amazing accent amongst all the Americans. When not sharing her life with PLC's kids in Iraq, she served other constituent groups with her rehabilitative skills and compassion.

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	Matt Willingham is the PLC press secretary and writes primarily on politics, history, general updates and visual peacemaking through photography and film.
	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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