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)

In A Word: “Neighbors”

December 7, 2011 by matt · Leave a Comment 

Haka ta nazani, chava da jeerani.
-Kurdish proverb

Translation: “If you don’t know, look to your neighbor.”

Photo by Jamal Penjweny

In A Word: “Mend”

November 30, 2011 by Lydia · Leave a Comment 

To see more by Polish artist/cartoonist Pawel Kuczynski, go here.

In A Word: “The Face of Injustice”

July 20, 2011 by Lydia · 1 Comment 

A temporary installation piece located in the UCMK Gallery, UK. This photo-montage is made out of 3,000+ photos taken inside of one of the cells of Amna Suraka. Now a museum, Amna Suraka was once a Ba’athist regime prison and torture chamber in the northern city of Sulaymaniyah.

3 Reasons For “In A Word” Mid-Week Photos

June 12, 2011 by Liz · Leave a Comment 

For a month now we’ve posted mid-week photos titled “In a Word,” and we’ve received some great feedback from you guys.

We want you to know that these aren’t just pretty pictures, they’re tools to help as all build an understanding of Iraq through the artists who live here.

We know you care about the future of Iraq, the kids and the training of nurses and doctors, but we want to offer you even more perspectives.

So here are 3 reasons we believe “In A Word” matters:

1. Images can be used to promote peace.
“Peace is waged when a child is served, a voice is heard, a story is told, a dialogue is created, and a community is engaged.”

We’re waging peace when we LISTEN to and TELL a story about Iraq, kids with CHD, local healthcare, local solutions (i.e. politicians, donors, doctors, etc.), Muslim and Eastern perspectives, Christian and Western perspectives, the war, etc. These photos give us the opportunity to engage another community. They tell stories and create dialogue.
They’re opportunities for us to understand.

2. We live among the people here.
We work with them, care for them, argue with them – we love them. And many of you have expressed interest in what those things look like here, so “In A Word” is our way of helping you visualize our day-to-day. It helps our families, friends and supporters ‘come around’, and for a few seconds, that makes us feel like you aren’t an ocean away.

3. It’s a platform for artists.
These Iraqi and Kurdish artists are unsung heroes, and their work deserves to be showed off and shared. They show their people that beauty can bring hope and truth in the midst of devastation.

“In A Word” is a forum – a sounding board – where artists can show off their work and prove emphatically: we’re here, and we’re talented.

Do you have any photos that you’d like to submit for an “In A Word” midweek post? If so send to liz@preemptivelove.org, subject “In A Word”

Practicing The Art (and Reviewing the Basics) Of Taking Care Of Sick Children

February 25, 2011 by Cody · 1 Comment 

“Heart surgery is an art.” Dr. William Novick, ICHF Heart Surgeon

If heart surgery is an art, then a Remedy Mission would be the art studio. It’s the place where teaching happens and inspiration is born. It’s a place where masterpieces are created alongside artists.

But it’s an art that everybody in the heart center gets to play a role in. Whereas an artist can create a beautiful piece on his own, a heart surgeon can’t perform a flawless surgery without a team around him. When they work together and finish their part, the piece is carefully passed along where it’s taken over by the nurses in the intensive care unit.

Without a strong nursing staff, the masterpiece would never be completed.

Teaching all of this is an art as well.

In the same day a local surgeon is having his skills refined as he patches a hole in a heart and the nurses in the ICU are being taught the foundations of nursing.

In the West, we have benefited from governments who have been able to spend BILLIONS on health care, education, and creating awareness about best practices, and things like hygiene from the time we were in elementary school.

At Iraq’s lowest point under Saddam, the Ba’ath regime spent less than one dollar per person on health care each year. While other parts of the world were thriving, Iraq’s health care system – along with their doctors and nurses – weren’t given what they needed to keep up.

Our Remedy Mission comes at a pivotal time in Iraq. A time where they now have the opportunity to be invest like never before.

It was sobering when we heard that little Alawi is trying to fight off a bacterial infection in his chest, something that is easily caused in an ICU which doesn’t even have a sink or soap with which to wash your hands. Don’t worry, we’re trying to work with local officials to get that retrofitted!

Through our Remedy Missions we’re helping raise up local health care systems that excel in the complex but also in the fundamentals of taking care of children.

All of it goes into creating a masterpiece.

We couldn’t do this without a coalition that cared as much about this as you do!

You’re a part of the masterpiece.

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

Report on “Iraq: The Forgotten Story” Art Show in UK & Beyond (VIDEO)

June 18, 2009 by Jeremy · 673 Comments 

On May 22, 2009, the Preemptive Love Coalition unveiled IRAQ – THE FORGOTTEN STORY at our inaugural event outside London, England. The Forgotten Story features the work of 6 Iraqi artists and tells the story of life in Iraq under Saddam Hussein’s Ba’ath Regime through their eyes.

The above video was compiled by a Kurdish company out of London that attended the event.

All proceeds from events, donations, and sales of this art help the Preemptive Love Coalition give life-saving heart surgeries to Iraqi children and create cooperation between communities at odds.

Iraq: The Forgotten Story Unveiled in England

May 23, 2009 by Jeremy · Comments Off 

Shortly after we began our work in 2007, under the direction of PLC co-founder Cody Fisher, the Preemptive Love Coalition set out to use original Iraqi art as a means of fulfilling our three-fold mission of (1) funding life-saving heart surgeries for Iraqi kids; (2) increasing cooperation between communities at odds; (3) and investing foreign revenue into local Iraqi economies.

On May 22, 2009, the Preemptive Love Coalition unveiled IRAQ – THE FORGOTTEN STORY at our inaugural event outside London, England. The Forgotten Story features the work of 6 Iraqi artists and tells the story of life in Iraq under Saddam Hussein’s Ba’ath Regime through their eyes.

But this is not a backward looking collection. The purpose of pulling together these stories and touring them around the world is to look forward together, for the future of Iraq.

For more information on the current event in Luton, England and for inquiries about future events, please visit our partners, A Thin Place, at www.AThinPlace.org.

SAMPLES OF FINE & PHOTOGRAPHIC ART

PHOTOS FROM THE OPENING EVENT

PARTNERS & SPONSORS

Filed Under: A Thin Place, Amazed, Art, Go Blog It!, Photography Tagged: A Thin Place, Art, Cody Fisher, England, exhibit, Forgotten Story, Iraq, Iraq: Forgotten Story, Jeremy Courtney, Luton, Photography, PLC

“Iraq – A New Face” at the Green House Gallery

April 16, 2009 by Jeremy · 350 Comments 

Some of our good friends, Ian (of Wales) and Ben (of England), are helping PLC to launch our global tour of the works of ten Iraqi artists (painters and photographers).  They came to visit in February to help make sure that all of the art would be selected and handled professionally.

The Luton Duo shot quite a bit of their own arresting photography while they were here and they’ve currently got it on exhibit as “Iraq – A New Face” at Luton’s Green House Gallery through May 17th.

For more information on this installation, grab this flyer or visit A Thin Place international artists collective.

Filed Under: A Thin Place, Art, Photography Tagged: A Thin Place, Art, England, Green House Gallery, Iraq, Iraq- A New Face, Kurdistan, Luton, Luton Duo, Photography

Comedy for Charity

September 28, 2007 by Jeremy · 182 Comments 

The amazing Ben Humeniuk donated this work of art to the Buy Shoes. Save Lives. cause. Feel free to grab it and post it on your website – we think it’s incredible!

Filed Under: Coverage, Go Blog It!, News Tagged: Art, Ben Humeniuk, Buy Shoes. Save Lives., comedy, materialism

T-Shirt Added to Store

September 1, 2007 by Jeremy · 1 Comment 

You now have the chance to wear the amazing skill of designer Carissa Phillips on your back. Most people get art and hang it on a wall. But we believe that certain art should be worn; particularly art like that of Carissa Phillips.

So head over to the store and check out the shirt.

A few people this weekend grabbed the brand new shirt for free due to an error in our IT Department.

As with everything at BSSL, profits go to save lives. And, you save us from needing a marketing budget when you were the message wherever you go! Everybody wins…

So grab a shirt. And for all those people you’ve already told about Buy Shoes. Save Lives. who said, “Cool idea, but I don’t have $100.” Let them know that saving lives just became a whole lot easier.

- Staff

Filed Under: News, Store Tagged: Art, BSSL, Buy Shoes. Save Lives., Carissa Phillips, clothes, design, free, shirt, T-shirt