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)

We’re Launching The ^#1 Surgical Training Program In All Of Iraq!

July 26, 2012 by Cody · Leave a Comment 

It seems fitting that all of this starts with a little boy named Haydar.

Haydar means “lion” in Arabic and when the local doctors in Nasiriyah, Iraq sent us a list of 500 children that they wanted to save during the Remedy Fellowship, Haydar was sitting at the top of the list.

And so the ^#1 surgical training program in all of Iraq—Remedy Fellowship—is set to begin in just a few hours with a lifesaving operation for Haydar!

Haydar will be followed by hundreds more in the coming months as the Remedy Fellowship provides 47 weeks of lifesaving surgery and training to doctors and nurses from all over Iraq.

But before we begin by saving Haydar, I want to thank you, because I know that all of this began with you.

It began with us telling you how we have the incredible opportunity to partner with Iraq and save hundreds of lives while giving the Nasiriyah Heart Center their best chance at becoming a sustainable and enduring local solution for children all over Iraq who have been born with heart defects.

Then you joined us. You donated your hard-earned money and you used your voice to ensure that the people of Iraq were given this opportunity.

And it worked—you’ve given us everything we need to launch the Fellowship today!

It’s made all the difference for Haydar.

Thank you!

Our Partners:

Arm-In-Arm With Excellent People—Meet Our Partners!

March 1, 2012 by matt · Comments Off 

Remedy Mission IX is at an end, and it’s success is more proof that you’re building something amazing here in Iraq.

It started with one little boy all those years ago, and now you are empowering on-the-ground specialists to train and save hundreds (and eventually thousands) of lives—you’re making all the difference!

So we thought we’d re-introduce you to our larger team in Iraq so you can know who does what around here.

The International Children’s Heart Foundation, or ICHF for short. These are our medical partners. Each mission they draw from an outstanding collection of volunteer nurses and doctors who are willing to spend their vacation time working for free in developing countries. How ’bout that for a holiday!?

Living Light International (LLI) completes this triumvirate by acting as our cultural compass. Their guidance and know-how make these surgical missions possible, and they’re incredibly well-connected. They make expansion to new frontiers and hospitals in Iraq possible, and they’ll even teach you some Arabic if you ask nicely.

Teaming up with these two has already left hundreds of families with now-healthy children, and we’re excited to save many more down the road!

Onward!

Our Partners:

Doctor Or Doll-Maker?—A Six Year-Old’s Dream Dilemma!

February 23, 2012 by matt · Comments Off 

I got word that our pig-tailed girl in the red coat left the ICU and was resting in her hospital room up on the sixth floor. So I grabbed my translator-friend and made the climb to hear more of Zahraa’s story.

Her father welcomed me into their room and we all sat down. He jumped right in and explained that his family had looked for a surgery for 3 years and spent over 17 million Iraqi dinar (nearly $15,000) on their search.

Zahraa had even been scheduled for surgery 7 other times, but each resulted in cancelation. Sometimes Zahraa got sick, and other times the Iraqi doctors got cold feet. It was a lot of disappointment to stomach.

But the mood couldn’t stay sad, because Zahraa’s life had already been saved! Her father beamed with joy and gratitude as he shared of his daughter’s dreams: “She begs me for sewing supplies. She wants to make dolls for herself and her friends.”

He went on to explain that the recent surgery made her want to be a doctor. She still wants sewing supplies, but she can’t decide if she would rather use them to make dolls for her friends or to give her friends stitches!

Regardless, Zahraa now has this and many other choices ahead of her because of your generosity! Thank for saving the life of this precious little girl!

Our Partners:

Her Name Is Zahraa, And She Probably Loves You

February 20, 2012 by matt · Comments Off 

We passed the midway point of Remedy Mission IX, and, for me, everything seemed to be moving in slow-motion.

It was the best problem any hospital could hope for: boredom.

When the alternatives are problems like drama between medical staff, complications in the ICU, or even death, I’ll take boredom any day!

I had already completed my morning rounds of photos and family meet-’n-greets, and I was back dozing in the break room, debating whether or not to eat an extremely unripe banana.

Then the break room door opened and in walked the little girl in the red coat. She was hugging a doll and squeaking something at me in Arabic.

Her dad poked his head into the room, apparently glad to have found her. He seemed embarrassed by her intrusion, but we invited them to sit and share their story.

I learned that the girl’s name is Zahraa, she is 6 years old, she has a beyond-your-typical-little-girl obsession with dolls, and she needs an urgent heart surgery.

While talking with her father, Zahraa leaned toward me from her dad’s arms and whispered something to me in Arabic.

“She says she loves you,” a translator explained.

Initiating heart meltdown.

As if that wasn’t enough, she proceeded to grab my head and kiss me on the cheek and then to tell everyone else in the room that she loved them, too. Her malformed heart certainly has no trouble expressing love! But she still needs an operation and, according to her father, it is scheduled to happen soon.

Come back tomorrow and I’ll tell you more about the little girl in the red coat and her (hopefully) lifesaving operation!

Our Partners:

Meet Ali!

January 15, 2012 by Cody · Comments Off 

A lot of you met Ali already, when he welcomed you to Remedy.

Whether he’ll admit it or not, he’s the ringleader and the brains behind The Fantastic Five. When Ali and The Fantastic Five aren’t by my side, it usually means I’m in the OR or in a meeting, in which case Ali will patiently sit right outside the door separating us. Just last night he called me over a dozen times on my phone, asking how I was doing and exhausting all of the Arabic I know.

What excites me the most about my friend Ali, though, is what he wants to be when he grows up. He wants to become a heart surgeon.

Yesterday we sat down and talked about his heart defect and I asked him why he wanted to become a heart surgeon. He responded, “I want to save others like me.”

If all goes well, Ali is just days away from his lifesaving heart surgery, where he’ll be saved by a heart surgeon and his team. I asked Ali if he’s excited for his surgery and he gave me a thumbs up and said “Yes – Yes!”

Ali is one day closer to being saved and getting the chance to save others…stay tuned!

Our Partners:

Tarza Arrives In Jordan

November 4, 2008 by Jeremy · Comments Off 

Late this afternoon we welcomed Rezhin and her mother, along with Tarza and her mother. We’d hoped to receive them Sunday evening but needed to wait until today. Once here at the house, we were all thankful to have Sara‘s father to help us communicate with one another. Neither of these mothers speak Arabic or English, so we’re really hoping that translation will be available for all of us during their stay here.

Tonight at the house the three little girls (Rezhin, Tarza and Sara) are all feeling shy, and therefore have not yet begun to play together. Since Rezhin will not have her first echo until Thursday, we’re hoping that they will enjoy playing with one another in the morning after a good night’s sleep.

Rezhin Arrives In Jordan

November 4, 2008 by Jeremy · 14 Comments 

Late this afternoon we welcomed Rezhin and her mother, along with Tarza and her mother. We’d hoped to receive them Sunday evening but needed to wait until today. Once here at the house, we were all thankful to have Sara‘s father to help us communicate with one another. Neither of these mothers speak Arabic or English, so we’re really hoping that translation will be available for all of us during their stay here.

Tonight at the house the three little girls (Rezhin, Tarza and Sara) are all feeling shy, and therefore have not yet begun to play together. Since Rezhin will not have her first echo until Thursday, we’re hoping that they will enjoy playing with one another in the morning after a good night’s sleep.

Kurdish Student Organization Raises $ for PLC

October 26, 2008 by Jeremy · Comments Off 

The Kurdish Student Organization at George Mason University in Fairfax, VA has been out and about raising funds for Kurdish and Arab children in need of heart surgeries outside Iraq.

From cookie bakes to candy sales – and an upcoming night of live comedy and music performances – the KSO is epitomizing all the ways we at PLC long to see normal people own this vision and share responsibility for the well-being of these kids.

Are you out doing something to promote PLC or raise money for Iraqi kids? Let us know here!

Current News Coverage of BSSL in Iraq

September 13, 2007 by Jeremy · Comments Off 

Thanks to all of the journalists and newspapers who have put out time and effort to promote healthcare to Iraqi children through Buy Shoes. Save Lives. Check out the articles below to hear what they had to say (assuming you know English, Kurdish, or Arabic).Thanks!

-BSSL