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 Making History—Three “Firsts” In One Week!

July 20, 2012 by Alicia · Leave a Comment 

This has been an amazing week!
It was so exciting to be a part of Remedy Mission X. It feels like I hear about new firsts every day:

We’re the first American team to come to Fallujah General Hospital since the war.

This is the first cardiac catheterization lab built in the hospital’s history.

This week was the first time the lab is used.

But most exciting of all: this is PLC’s first Remedy Mission in Fallujah. It’s been a week of history in the making!

Some of the most exciting firsts involved the groundbreaking catheterization procedures (‘caths’). We treated 12 children over the week and the first three days gave us a chance to break the cath lab in.

On the first day of the mission, we performed the FIRST diagnostic cath on 2 year-old Balkis. He has two holes in his heart, known as ventricular septal defects (VSDs). The doctors knew he had these holes because of an ECHO screening done by a local Iraqi cardiologist and verified by Dr. Kirk on our first day in Fallujah. To fix them, Balkis will need surgery. But the surgeons have to know lots of detailed information about the hole and the status of his heart and lungs. The diagnostic cath provided that information.

Balkis can now safely have surgery at any hospital because his parents can take the cath report to any heart surgeon and they’ll know exactly what they need to know!

The second day we performed the FIRST PDA closure in 13 year-old Sara. A PDA (patent ductus arteriosus) is an abnormal connection between the two biggest vessels coming off the heart. However, a simple coil placed in the PDA acts as a plug that closes the connection.

It’s incredible that such a tiny piece of metal could have INSTANT results in changing the blood flow in Sara’s heart. Before her cath, I could literally feel the vibrations of blood flowing abnormally. But immediately afterwards, her heart felt normal! Amazing! She is the first of many more children to be cured by caths in Fallujah General Hospital!

The third day, we performed the FIRST heart valve widening on 5 year old Rawan. Her pulmonary valve was too small for blood to flow smoothly which could have led to heart failure. However, Rawan was treated by a cath that used a balloon to physically stretch out the valve. Now the blood can flow normally, and Rawan can be active and play without her heart getting tired out!

All of these “firsts” were exciting for the local Iraqi medical staff, local and international news agencies, and government officials. But despite the thrill of being a part of a “first”, the greatest impact of the new cath lab won’t be seen for years to come, after countless more children undergo procedures at Fallujah General.

Each child who received a cath had their lives changed forever, especially those who received interventional procedures. To them, it didn’t matter whether they were the first or the last, it just mattered that they were able to be treated.

We have the amazing opportunity to change the course of history here in Fallujah and it’s thanks to your support—thank you for making this trip possible! We helped 12 children and spread goodwill through their families on your behalf, and we can’t wait to come back!

Our 85 suture kits are FULLY funded — Thank you for helping fund $765 worth of medical supplies!

Our Partners:

Jeen Mustafa is Leaving for Surgery on Saturday

July 15, 2010 by Jeremy · 1 Comment 

Meet Jeen Mustafa. Jeen is currently living with Atrial Septal Defect (ASD), which affects the two upper chambers of the heart. Her disease creates a hole between the two upper chambers of the heart, mixing the blood going to the lungs with the blood going to the rest of the body. Because of your financial help, Jeen is leaving for surgery on July 18 along with 4 other children with congenital heart disease. Jeen will be receiving a non-invasive surgery through catheter, which also significantly reduces the danger of the procedure.

Follow Jeen on Twitter: @JeenMustafa. Subscribe to Jeen’s updates via RSS HERE.

Total Correction for Muhammed!

February 25, 2010 by Jeremy · Comments Off 

Doctors accomplished the total correction they were hoping for with Muhammed. But he came to us with extremely high pulmonary pressure (in his lungs) so the coming days in ICU will be incredibly important.

Special thanks to Erica Fischer of EMF Images for partnering with us to save Muhammed’s life. At the suggestion of EMF’s Erica Fischer, Cameron and Ben (left) donated the sitting fee for their engagement pictures to the Preemptive Love Coalition to help fund Muhammed’s surgery. This ongoing partnership with EMF promises to save a lot of lives in Iraq and engage the hearts of many who thought they were just signing up for EMF’s great photography!

We know there are hundreds of you out there doing amazing stuff like this to save lives. Sometimes we just don’t know what you’re up to! Contact us.

Follow Muhammed Adnan on Twitter: @MuhammedAdnan. Subscribe to Muhammed’s updates via RSS HERE. Follow Muhammed’s thread of longer stories (with pictures & video) on the PLC blog HERE.

Meet Muhammed (Twitter: @MuhammedAdnan)

February 24, 2010 by Jeremy · Comments Off 

Muhammed’s presence in our life is a testament to the way the Preemptive Love Family Services Team has lived out our Core Values – namely, our pursuit of excellence (or constant improvement) and the way we seek to provide whole solutions for whole people. But all that sounds a little vague, so let me break it down…

In February 2009 a Kurdish soldier knocked on the door of our office. Though I hadn’t done anything wrong, I was sure I was about to be hauled in to give an account for something ridiculous. Thankfully, I was wrong. His name was Hywa and his daughter needed a life-saving surgery…. very urgently. We fast-tracked his family to surgery, but unfortunately he had already missed the optimal surgery window for his daughter when he first appealed to us. His little baby died in March 2009.

But Hywa and I formed a friendship that was somehow wrapped up in our mutual efforts to save his child’s life. When we put Honyar on that plane to Istanbul there was an initial feeling that we had both succeeded. And as I stayed back with him in Iraq, we cried together, somehow feeling like we had both failed that day she died. Of course, it was not the same grief for me as it was for him, and I would dishonor him to imply otherwise. But we celebrated, mourned, and grew together.

A few months later Hywa referred his friend Sami to us because Sami’s boy Danar was dying from a similar heart defect. We sent Danar to surgery in January 2010 and Danar can be seen doing really well after his surgery in our video of follow-up echos a few days ago.

After Danar returned from surgery, his father, Sami, referred Adnan to us because Adnan’s son is similarly facing death from extremely high pressure in his lungs as a result of two large holes in his heart.

Call it the “butterfly effect” or “serendipity” or “Providence” or a “job well done.” I’m really proud of our Family Services Team and all the work they’ve done to leave a lasting impact on families like Hywa, Sami, and… hopefully… little Muhammed’s family.

Follow Muhammed Adnan on Twitter: @MuhammedAdnan. Subscribe to Muhammed’s updates via RSS HERE. Follow Muhammed’s thread of longer stories (with pictures & video) on the PLC blog HERE.

*In accordance with PLC’s desire to lend a hand-up by avoiding strict hand-outs (when possible), Muhammed’s family told us they would sell their car to help their son and ultimately gave $6,500 towards PLC’s highly-discounted surgery prices.

Meet Soma Salah (Twitter: @SomaSalah)

January 6, 2010 by Jeremy · 16 Comments 

It’s hard to know what to say about Soma – there is so much to tell. She’s from a village in Iraq that was utterly destroyed by Saddam Hussein. Her father was tortured by Saddam’s Ba’athist regime by electric shock and now suffers neurological difficulties as a result. And to complicate it all, after losing a child on the second day of birth, Soma’s parents learned when Soma was just a few days old that she was born with a congenital heart disease.

We’re taking her to Istanbul, Turkey for what we hope will be a life-saving heart surgery.

Special thanks to the college students of FWCM.org for their phenomenal $14,800+ two week fundraising campaign for Soma and one other child. Your passion and effectiveness in fundraising is a testament to the faith, values and lifestyle you profess. We’re looking for 12 other houses of worship, schools, and clubs to partner with us in 2010. Click here for more on our Fifty Family Focus.

PRINT & PASS ALONG SOMA’S HOPE CARD HERE.

Follow baby Soma on Twitter: @SomaSalah. Subscribe to Soma’s updates via RSS HERE. Follow Soma’s thread of longer stories (with pictures & video) on the PLC blog HERE.

—————–

ADDITIONAL LOCAL FUNDING BY:

* FAMILY FUNDING		KURDISTAN SAVE THE CHILDREN
*In accordance with PLC’s desire to lend a hand-up by avoiding strict hand-outs (when possible), Soma’s family – though living in the poorest area we’ve ever seen in Iraq – was able to work with local government and family to provide $3,500 towards PLC’s highly-discounted surgery prices.

Meet Mazyar

July 20, 2009 by Jessica · 117 Comments 

Mazyar is a cute little three year old boy from the city in Iraq where PLC has our office. Like many of the children we know about, Mazyar’s condition is very complicated. He received an operation last year in Tehran, but it was only stage one of a full-correction. PLC is coming alongside his family in this second surgery in as many years to help Mazyar receive the full correction – and hopefully the full life – that every parent wants for their child.

Mazyar also has a cleft lip. We have made inquiries into charitable surgical options for him while in Turkey, but as yet we have not made any definitive plans for a cleft correction.

Follow 3-year-old Mazyar on Twitter: @mazyartahir. Subscribe to Mazyar’s updates via RSS here. Follow Mazyar’s thread of longer stories (with pictures) on the PLC blog here.

NOTE: In accordance with PLC’s desire to lend a hand-up by avoiding strict hand-outs (when possible), Mazyar’s family has funded approximately $2,500 of PLC’s highly-discounted surgery price themselves.

Lawen is Receiving Life Now!

June 1, 2009 by Jeremy · Comments Off 

I just walked 16-year-old Lawen down to her cardiac catheterization procedure, where she is receiving an umbrella-like closure device inserted through the artery in her thigh to close a .55 inch hole in her atrium. This will allow her to finish school, go to college, one day marry, have kids, and grow well into adulthood.

Thanks for all of you who have contributed so graciously to Lawen’s surgery!

Lawen to Receive ♥ Correction with Umbrella Device via Thigh

May 31, 2009 by Jeremy · Comments Off 

We ordered an $8,000 corrective [umbrella] device and Lawen will receive her repair on Sunday night or Monday morning.

Roman is Doing Amazing & Out of ICU with his Mother

May 28, 2009 by Jeremy · Comments Off 

This is a picture of Roman after surgery. This little two year old was rushed into our group at the last minute due to what the Iraqi doctors understood to be the urgency of his condition.

Just these few days later and he has been released from ICU and is playing with cars in his room, watching TV, eating soup, and doing wonderfully!

Photo: Matt Addington

Ahmad Out of Surgery! No More Blue Skin! All is Pink & Healthy!

February 17, 2009 by Jeremy · 769 Comments 

Ahmed is out of surgery. His oxygen levels are already up by 25%. His future is hopefully less blue and a more healthy pink. His dad is crying tears of joy.

Dr. Çiçek at the Anadolu Sağlik Merkezi was clear that this is not a long-term, fully corrective solution; but this first surgery should allow him to finally live long enough to receive the staged surgeries he’ll need over the coming years to actually live a fully functional adult life.

We’ll update with more information as soon as we know it.

Follow Ahmad’s daily updates on Twitter or via his RSS feed.

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