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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]

When Words Aren't Cheap

November 12, 2008 by Jeremy · Comments Off

A good portion of our work in the Preemptive Love Coalition involves words. Talking, emailing, blogging, marketing, speaking – we do it all. We talk consistently about funding life-saving heart surgeries for over 3,000 Iraqi kids who are dying on a waiting list. We talk about the need for an urgent intervention of love just so that these kids can survive into adulthood.

Sometimes I wonder if language like that overdoes things a bit. I can’t help some days but feel like it is too hyperbolic, too dramatic.

Today, I don’t feel like that at all.

Two nights ago we got an email from our partnering organization, Brothers Together. When 10-month-old Mohammed got off the plane in Amman for a pre-op screening, his skin was a deep shade of blue from insufficient oxygenation of his blood. He was gasping for breath. They rushed him to the hospital.

But it was too late.

Ten-month-old Mohammed died yesterday.

We’ll probably know more in the next few days about the complications that might have brought this about, about why we lost him on the threshold of hope, about why his heart couldn’t make it just a few weeks more until he could have had surgery that would have probably saved his life. But we already know the three most important facts in the matter:

Mohammed was born with a broken heart.
Mohammed died from a broken heart.
There are still over 3,000 Iraqi kids who are just like Mohammed.

Then, just yesterday, we got a second email: a second child had died during the screening procedures.

So maybe all this talk of “life-saving heart surgeries” and “dying on a waiting list” is just a language game — but it is one that is played for keeps. Dramatic words speak to dramatic realities.

natural balance dog food coupons printable

idth=”270″ height=”484″ />There are plenty of you who are thinking these days about what you might give to family and friends to celebrate the upcoming holidays of Christmas, Eid al-Fitr and Hannukah. Many of you get frustrated with the triviality of the tokens we exchange in celebration of God’s faithful compassion represented by these holidays.

If that’s you, I would recommend clicking on the graphic to the left and giving a “Gift of the Heart” this Christmas. You can give a gift (of any amount you choose) in honor of someone you love that will help to save the life of an Iraqi child, whom God loves. (The good news is, he also loves you and the people you love, too!)

And once you give, there is a very nice certificate that you can download to present to your loved one to share with them about the gift of hope, life and a new heart that you are celebrating with them this season.

You could also become a monthly sponsor (again, of any amount you choose) that would allow you to regularly contribute throughout the coming year towards funding life-saving heart surgeries for Iraqi kids whose days are running out without urgent, sacrificial generosity from people like you.

But even dark days like these bring hope. One teenage child was turned away at the last screening because his body was too weak for surgery. The combined effects of his heart defect and raging tuberculosis caused one of the Jewish doctors examining him to compare him to a victim of the Auschwitz concentration camp. But after careful treatment for his TB and close attention to his nutrition, Akram is now ready for surgery that will help bring him to a level of health he has never known before.

Give today so that we don’t have to keep Akram waiting again until it is too late.

Filed Under: Heart Surgery, News, Our Kids, Sad Tagged: Akram, broken hearts, Brothers Together, complications, contribute, donate, give, Jeremy Courtney, mohammed, TB

Aras Arrives in Amman, Jordan!

November 28, 2007 by Jeremy · 456 Comments

A few weeks ago Buy Shoes. Save Lives. took stock of our assets, our debts, our inventory, and our projected future needs and determined that it was time to give a significant chunk of our money to a child named Aras from the Kurdish city of Halabja in Iraq.

Halabja now stands as an emblem of suffering for the Kurdish people; the site of Saddam Hussein’s March 16, 1988 gas attack against Kurds in which 5,000 died in one day.

It felt significant and symbolic to make our first child the child of the city whose scars are carried on today by children who suffer heart disease – nearly 20 years later – because of the gas attacks of that day.

We were nine and younger in 1988, and yet we feel our hands are dirty and that we am somehow complicit in the problems and pains of Aras’ people. $5,000 cannot repair decades of hurt – and decades to come – but as far as feelings go, it felt good to give our money away to Aras and his family.

Today Cody escorted a very nervous Aras and his mother to the airport, where they flew for the first time, and landed many delayed hours later in Amman, Jordan. They were greeted by one of the many partners in this endeavor, Brothers Together. Aras should be headed on to Jordan later this week for surgery.

We are nearly speechless at how amazing this has been. And we’re fairly certain we’ve received new hearts in this process, as well.

Filed Under: Amazed, Giving Away Money, Heart Surgery, News, Our Kids, Surgery Updates Tagged: Amman, Aras, assets, Brothers Together, Buy Shoes. Save Lives., buyshoessavelives, CHD, Cody Fisher, halabja, Heart Surgery, Iraq, Jeremy Courtney, Jordan, kurds, saddam hussein, stock

Hussein’s Sister Died of Heart Complications

November 8, 2007 by Jeremy · Comments Off

This is cross-posted from our partner Brothers Together’s site. We wanted you to hear this story so you could feel the gravity of the problem these famillies face.

Tuesday, November 6, 2007
Sister Died of Heart Disease
Filed by Donna Petrel

A sleepy Hussein arrived with his mother from the Save A Child’s Heart house this morning, along with Mustafa and his mother, for his echo and further tests. Yesterday Dr. Katz attempted to do an initial echo on Hussein, but none of us could settle him down enough for the echo to be done. Because it was late in a very long day, the doctor decided that waiting until today would be best for all of us, and dismissed Hussein to the SACH house. This morning Hussein was given a syrup to make him sleepy so he would not be distressed over the echo, and even though he arrived at the hospital already sleepy, this did not stop his fearful fretting for quite awhile. Yet when he finally fell asleep, he was peaceful during an hour-plus long echo by several doctors who were discussing his complicated case as they went through the examination. Hussein awoke before the end of the exam, and Dr. Tamir spoke to him gently about helping him grow up to be a big boy, which seemed to settle him back down so the exam could be finished to the doctor’s satisfaction.

During today’s exam when Dr. Tamir took some family information about Hussein, his mother told of the death of an older daughter who also apparently had heart problems. She told of how the doctors in Iraq could not help her after she was admitted to the hospital at the age of nineteen, and so after four months, the daughter died. She had shared with me in Amman that one of her children died, but she did not tell me the details. After hearing this today, it helped me realize why she is so anxious to know whether Hussein will be able to have surgery or not.

Later in the day as Hussein still waited at the hospital, this usually shy boy was content to go to the children’s playroom where they were making balloon animals. He also enjoyed playing with his friend Mustafa and visiting with Hedi in his room there. It was determined that both Hussein and Mustafa could return to the SACH house for the night, and come back for more testing later in the week. Tomorrow we hope to visit them there. Please keep praying for Hussein and his mother as they wait for the surgery which will give him a new heart, and give joy to the heart of his dear mother.

Filed Under: Heart Surgery, Our Kids, Partnerships, Sad Tagged: anxious, Brothers Together, Donna Petrel, Dr. Katz, Dr. Tamir, echocardiogram, family, healed heart, hospital, Hussein, Jeremy Courtney, Mustafa, pray, prayers, Save a Child's Heart

Anonymous Donor Partially Funds Two Children for Buy Shoes. Save Lives.

November 6, 2007 by Jeremy · Comments Off

Hedi, 8 months old

Thanks to an anonymous gift directly to our partner organization on behalf of Buy Shoes. Save Lives., Hedi will be able to have the operation he needs to fix the hole between the ventricles of his heart. Your advocacy among your friends is apparently working! Keep it up!

Hussein, 3 years old

Hussein is from one of the few Arab (non-Kurdish) families who made it safely to the October screening. Doctors singled him out as urgent, as he periodically runs out of breath and cries. Our partners at Brothers Together took him across the Jordan River Monday with Hedi (above), and thanks to an anonymous gift on behalf of Buy Shoes. Save Lives., his sponsorship was completed at three minutes to midnight the same day!

Filed Under: Amazed, Giving Away Money, Go Blog It!, Heart Surgery, Our Kids, Partnerships Tagged: Advocacy, anonymous, Arab, Brothers Together, BSSL, Buy Shoes. Save Lives., buyshoessavelives, grateful, Heart Surgery, Hedi, holes between the ventricles, Hussein, Iraq, Jeremy Courtney, Jordan, Jordan River, Kurdish, thank you

Buy Shoes. Save Lives. Signs w/ Kurdistan Save the Children

October 2, 2007 by Jeremy · 136 Comments

Today, by the grace of God, Buy Shoes. Save Lives. and Kurdistan Save the Children shook hands on a deal to partner together to address the needs of over 1,000 children registered with KSC who have congenital heart problems needing immediate surgery.

Buy Shoes. Save Lives. agrees to…

- commit as much money as we can to heart surgeries from shoe sales
- promote this cause through photography and video
- be the ambassador to Brothers Together and facilitate the sending of children

Kurdistan Save the Children agrees to…

- promote this cause also through documentaries on the children
- collect all the necessary medical documents

(and wait for it…wait for it…)

- give a MINIMUM of $10,000 a month directly to Buy Shoes. Save Lives. to be put towards heart surgeries via Brothers Together.

Additionally, KSC is seeking to expedite the visa process with the Iraqi Embassy in Jordan. They are also making efforts to get airfare at half price from Iraqi Air.

We are so pleased to see Kurdistan Save the Children and (Mrs.) Hêro Xan Talabanî get behind our efforts to get behind their children.

The Peace of God be with you…

Jeremy, Cody, Jessica & Michelle
Buy Shoes. Save Lives.

Filed Under: Amazed, Go Blog It!, News, Partnerships Tagged: Brothers Together, BSSL, Buy Shoes. Save Lives., buyshoessavelives, CHD, children, Congenital Heart Disease, deal, God, Hero Xan Talabani, Iraq, Iraqi Air, Iraqi children, Iraqi Embassy, Jeremy Courtney, Jordan, KSC, Kurdistan Save the Children, Photography, video, visa