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?"


----------

 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)

A Perfect Heartbeat—Maddy Made It!

December 18, 2012 by matt · Leave a Comment 

“It sounds perfect,” he whispered.

Dr. Mounaf (pictured above) was Maddy’s Iraqi surgeon-in-training during the operation, and he’s thrilled at how well the operation went. We originally thought Maddy would get a partial correction and then the final, complete correction would come later when he’d grown a bit.

But Maddy was fortunate, and his heart is now fully corrected—he won’t need another operation.

Dr. Mounaf listened to Maddy’s heart from all different angles as Frank—an ICU teaching nurse—explained the rhythms to him. Considering this is our 300th surgery, it’s exciting to see it go so well.

Thank you for making 300 of these little hearts beat correctly—they now sound the way they’re supposed to!

Stick with us. We’ll have more info on Maddy, Remedy Mission XIV, and the 300 children we’re set to help in 2013 coming soon.

Our Partners:

Meet The 300th Child You’ve Impacted!

December 13, 2012 by Jeremy · Leave a Comment 

Allow us to introduce you to a little boy named Maddy, the 300^th child you've impacted in Iraq! (It still seems surreal to type out that sentence!)

It may have been Maddy’s smile that won all of us over; or maybe the fact that he represents the 300^th child we’ve served over the past 5 years; or maybe both!

But despite all the celebrations and smiles here at Basra’s first Remedy Mission, the doctors are eager to work. They have waited 30 years to save children like Maddy, and now it’s time to make up for lost time!

So to celebrate Maddy's life we're doing something we've never done before. We're planning 300 more lifesaving heart surgeries—next year alone!

But we need your help. Your donations are making the biggest impact yet, and we can't let up.

This Christmas, help us save the next 300.

Whether it's a straight-up donation, a Christmas fundraising party, gifting our new lifesaving tee to your friends and family, or starting an online fundraiser—100% of the money donated is going towards saving the next 300.

	$9—Stitch a Heart Our partner surgeons use high-quality stitches (called “sutures”) to fix leaky heart valves, sew up holes, and close up wounds after surgery. For just $9, you can help us save a child’s life—perfect for an office party or stocking stuffer!
	$50—Patch a Heart Our partner surgeons and nurses make heart patches for each child during their operation from a sheet of material called “Gore-Tex.” For just $50, you can fill the gap in a child’s heart and help save their life!
	$500—Package of Patches Your gift will help us buy enough material to create the patches and change the lives of ten children suffering from life-threatening holes in the walls of their hearts.
	$1,000—Heartmender Package Your gift will help us buy all the medicines, sutures, patches and a portion of the airfare for our doctors and nurses required to save one child’s life on our next Remedy Mission. In partnership with the Iraqi government, $1,000 is roughly what it costs PLC to save a life in Iraq.
	Start Your Own Fundraiser Online Today! You may feel like you only have a few dollars, but when you combine your best with those closest to you, you will quickly find that you can patch a heart—or fund an entire heart surgery—as a group. Click here to get started –>

This Is Your Chance To Double Your Impact In Iraq!

October 30, 2012 by matt · Leave a Comment 

We’re delighted to announce our partnership with One Day’s Wages (ODW), a grassroots movement of people dedicated to giving “one day’s wages” to impact the world and alleviate extreme global poverty.

ODW has pledged to help us raise the money we need to provide medical supplies for our upcoming Remedy Mission. To do that, ODW will match the $5,000 we raise with another $5,000—giving us the $10,000 we need to help save the lives of another 20+ children in Iraq.

That means your gift to this campaign will automatically be doubled, doubling the impact for children in Iraq!

To help us reach our goal and provide another lifesaving Remedy Mission, donate on ODW’s campaign page HERE.

Will you help us reach our goal of raising $5,000? We can’t do it without you!

How Newborn Babies in Dohuk Are Helping Us Shed Light On The Backlog

June 5, 2012 by Kendelyn · Leave a Comment 

I wasn’t sure what to expect when I got in the car and drove five hours north to the Kurdish city of Dohuk.

I was told we would be screening children for congenital heart disease (CHD), but since I’m not in the field of medicine and am a newcomer to PLC, I wasn’t exactly sure what that would look like. All I knew was that this was going to be a first-time experience for me and that I was excited.

I walked into the experience with an open mind and an open heart, and I walked away with a new understanding of what it means to screen babies for CHD and why that has everything to do with understanding and fighting the backlog of children waiting in line for lifesaving heart surgery here in Iraq.

In the end, we spent the week screening newborns using two echo machines. Dr. Kirk (whom we’ve partnered with before) preformed an echo using a V-scan, a pocket-sized ultrasound device while Dr. Serdar—the local Kurdish cardiologist who we partnered with for the mission—used a full-size echo machine.

Each morning we walked into the hospital and screened the children who were born that day as well as the children who were born the previous night. More often than not, grandmothers would carry in children who were barely minutes old. Their vibrancy and freshness to life continually brightened the room.

Along with the spirited children, we saw timid mothers, brand new fathers, and bashful siblings—all of which were hoping to hear good news about their brand new family member. It was such a joy to be able to see the relief and joy on many of the families’ faces as they heard the words “healthy heart!”

In addition to performing two screenings per a child, we conducted interviews with parents and close relatives of the babies. The interviews make up a collection of data on the parents of the child, which will later be analyzed by Dr. Kirk as he searches to better understand the conditions that lead to CHD.

By the close of the week, Dr. Kirk and Dr. Serdar felt well on their way to being able to make a more solid assessment of the CHD situation in the Dohuk region of Iraqi Kurdistan – and a more solid assessment is exactly what we need if we’re going to eradicate the backlog.

I feel truly blessed to have been a part of this screening mission. Not only did I learn a ton, but I forged new friendships and had an amazing time.

My Take—The Real Meaning of Mother’s Day

May 13, 2012 by matt · Leave a Comment 

We’re deviating from our typical Tuesday-Thursday regimen to bring you a Mother’s Day guest post by the excellent Kristine Brite McCormick.

Kristine is an advocate and activist based in Indiana, and she is responsible for many of the lifesaving operations we’ve provided over the years. Take a few minutes to read her story:

This Sunday will mark my fourth Mother’s Day. I have not held my baby in my arms for any of them.

I was pregnant Mother’s Day 2009. I got cards from my husband and mother, and thought about the next year when I’d wake up to a baby and be a “real mother.” My perception of a real mother was so off. In November, I gave birth to Cora, and she was perfect. Except I didn’t know she was born with a broken heart—congenital heart disease.

She died suddenly and unexpectedly only five days later. The last two Mother’s Days have been spent wishing I could hide from the day’s barrage of images of “perfect families.”

For too many mothers across the globe, Mother’s Day is spent not holding our babies, but visiting their grave stone, or in the hospital willing them to get better.

In Iraq, Mother’s Day for thousands of moms means knowing their child’s heart is a ticking time bomb. With every pump of blood, their child’s heart becomes a little more weakened. Without lifesaving surgery, they will die. It’s a fact, this will be the last Mother’s Day for hundreds of Iraqi mothers to hold their babies.

I won’t ever hold my daughter again. Instead, I throw all of my energy into hoping all moms see their babies become adults.

To the mothers sitting bedside in Iraq, hopelessly watching your child struggle, I’m glad the Preemptive Love Coalition is here. Hope is coming. It won’t come in time for all of you, but it’s coming. I promise to do everything I can to make it come faster, and I hope other moms will join me.

That’s the real meaning of Mother’s Day for me, working to make sure every mother gets to spend the day with her child, in the U.S., in Iraq, and across the world.

###

To see how Kristine is making lifesaving, legislative change on behalf of mothers, visit her website: www.KristineBrite.com

Surgery, the “Neglected Stepchild” of Global Health

April 3, 2011 by Alex · 1 Comment 

In preparing for my 2nd internship with PLC this summer I came across an article written by two well-known global health advocates and physicians (a prof at Harvard and the current president of Dartmouth, if you’re into credentials) on the topic of surgery in the global health movement. [Paul E. Farmer and Jim Y. Kim. 2008. "Surgery and Global Health: a View from Beyond the OR." World Journal of Surgery 32:533-536].

After discussing this article with one of the directors at PLC and thinking about our current model for surgical aid in Iraq, a few points stood out:

The authors’ first argument is that surgery is the “neglected stepchild of global healthcare.” The fact is, although surgical diseases (CHD being one of the most prevalent) are a major cause of death and disability in much of the world, the vast majority of healthcare programs don’t address surgical needs.

Why? Because surgical interventions are usually complicated and require a larger investment than other kinds of health interventions, and treating surgical diseases requires a more advanced infrastructure and the involvement of more professionals than treating, for instance, malnutrition or malaria.

There is also the fact that surgical diseases have lacked the same kind of advocacy and exposure that have led to funding and programs for “high-profile” diseases like tuberculosis or AIDS.

The other major issue addressed by Farmer and Kim is that countries that actually have the surgical services often only have them in just a few locales, and the treatment is usually too expensive to be accessible by most of the population.

The question then arises: how do we make this treatment available in settings where infrastructure is poor, trained professionals are scarce, equipment is needed, and “the only thing not needed is disease, which exists abundantly.”

Remedy Missions are our answer to that question.

As you know, we recently moved from sending children abroad for surgery to a model that provides more surgeries at less cost while simultaneously training local professionals.

These Remedy Missions specifically address the impediments to surgery in global health described by Farmer and Kim.

They provide treatment of CHD for families that would never be able to afford traveling abroad for surgery. Our work also means we’re freeing surgeons up to focus on surgery, because, as Farmer and Kim write, “clearly we don’t want surgeons to be dragged out of the operating room to manage logistics, supply chains…and financing.”

Remedy Missions provide crucial training for all the different health professionals that are required for a surgery to be successful (surgeons, cardiologists, nurses, etc.).

This process of providing surgery and training is also an exercise in infrastructure building as we work toward the development of heart centers in northern and southern Iraq. The fact that we can count both regional and national governments as partners addresses the need for surgical care in the public sector in Iraq, and it bodes especially well for poor families who will need to receive treatment in the future.

Lastly, the partnership and advocacy of our supporters (that’s YOU) is helping to raise awareness of the burden of CHD and other surgical diseases in places like Iraq.

With well-planned, structured interventions that take into account the needs and problems associated with surgical disease globally, and the support and advocacy of a Coalition of concerned individuals and communities (that’d be you again), problems like CHD can cease to be a “neglected stepchild” of global health and instead serve as a model for building health systems and effecting powerful change in global contexts.

Two Weeks Away From Surgery, Leah Continues to Grow and Develop

July 5, 2010 by Esther · Comments Off 

from Preemptive Love on Vimeo.

In a week and a half Baby Leah goes to surgery!

Those words bring so much joy to my heart because they signify the new life that successful heart surgery will give Leah.

Since the last time that we visited Leah, she has continued to grow and develop – rolling over with ease, bouncing off her mother’s lap, waving at others and attempting to hold herself up on her hands and knees.

This little girl, whose birth defects have threatened to steal her life away, now has the opportunity to have that life transformed because of the combined efforts of Turkish heart surgeons working to restore peace with their set of surgical tools along with the willingness of donors like you.

Leah is one of 4 Iraqi children that will be traveling to Turkey on July 18 for heart surgery because of your involvement and desire to combat the unnecessary deaths of children born with congenital heart disease.

Click HERE to follow Leah Ibrahim on Twitter as she gets ready for surgery.

Baroof’s Scar Stands Against Kurdish Terror and Turkish Oppression

July 4, 2010 by Jeremy · 1 Comment 

The photo above tells the story of an extremely different child than the one we met in March right before boarding a plane to Istanbul, Turkey. Three months ago Baroof received a rare and complicated surgery for his age – a surgery that ultimately has spared his life and ushered in a new season of joy and obvious strength.

But basking in this season of salvation isn’t quite as easy as it might be for other children in other places. Baroof’s family lives on the Iraq – Turkey border, where for years Kurdish separatist rebels (members of the Kurdish Worker’s Party or the PKK) have been mounting attacks against the Turkish government in pursuit of an independent Kurdish nation. In response to the PKK’s terrorizing of Turkish civilians and military personnel, the Turkish government often responds with a blunted hammer where a precision tool might have been more effective.

The activities of the PKK claim to be a response to Turkish oppression. And Turkish heavy-handedness claims to be a response to Kurdish terrorism. And thus, the cycle continues.

Because of this cycle, Baroof and his family have grown up with a relatively monochromatic view of Turks and Turkey – such as “Turks are the oppressors who kill our Kurdish cousins in Turkey and cross international borders into Iraq to kill our family here as well” or something similar.

In March, we helped throw a splash of color on that single story. What was once a black and white issue has been somewhat mitigated by the kind actions of Turkish doctors who give generously of themselves and their skills to serve children like Baroof. The kindness was not lost on Baroof or his family. Now back in Iraq after surgery, they express their gratitude to Kurds around them for the Turks who saved their son’s life, thereby pushing back a single story about Turkish oppression and easy justifications of Kurdish rebellion.

Some of Baroof’s tribal members and distant cousins have died at the hands of the Turkish military. Others likely bare the scars of near-misses and raids gone wrong. But Baroof’s scar is a line of love from your heart, through Istanbul, Turkey, all the way to the border of Turkey and Iraq.

Your financial gifts have enabled Turkish surgeons to write new language into the region.

Baroof starts school again in September. Because of you, his desk will not sit empty this year. Because of you, his Kurdish friends – who might otherwise be enticed into the ways of PKK terror – will constantly contend with the scar on his chest and the technicolor story it tells.

Soccer balls and Staircases Reflecting a Renewed Childhood

July 1, 2010 by Alex · Comments Off 

When I visted Ahmad earlier this week, I was struck by two objects that embodied the effect PLC has had on the life of a child who has undergone heart surgery.

The first was the metal staircase leading up to their home on the second level of the block. This old staircase was red, rickety, and full of holes — a lot like Ahmad’s heart was a year and a half ago. Ahmad had one of the most complex cases of heart disease PLC has seen. His combination of defects turned his lips, hands and feet blue from lack of oxygen and assured that he would not have a normal or lasting childhood. But thanks to your support, commitment from his family and the skill of medical professionals in Iraq and Turkey, Ahmad could greet us at the top of the stairs with a smile on his face.

Ahmad’s medical story is not finished. He still has some blue to his lips and will need more surgeries down the line; but a second powerful image — that of a tattered and beaten up soccer ball — made me realize how much of an impact his first surgery truly had.

Worn out soccer balls are certainly not uncommon in Iraq, and I probably wouldn’t have given Ahmad’s ball a second thought if his mother had not pointed out that this was the same ball that was given to him by PLC just a year ago. Ahmad, a boy who had not been able to run last year because of fatigue from a lack of oxygen, had beaten his new soccer ball to shreds playing with friends.

This is the impact Ahmad’s surgery has had. He may not have a totally corrected heart yet, but he does have a childhood — full of running, playing, laughing, falling, scraping knees and wearing out soccer balls.

Backed Into a Corner: Doctors Adapting to Hardships in Iraq

June 30, 2010 by Preston · Comments Off 

As a doctor, decisions that affect a person’s quality of life come with the job, and this is no different for our local cardiologist, Dr. Aso Faeq. While shadowing Dr. Aso in his office earlier this week, I witnessed how the problems in Iraq make these decisions even more difficult.

As I saw patient after patient visit Dr. Aso’s office last Wednesday, the fact that congenital heart disease is a rampant problem here in northern Iraq became blatantly obvious. Families drove for hours just to see this one cardiologist examine their child, and so many of them were told about the urgency of their child’s heart condition.

Though so many cases are urgent, Dr. Aso is restricted from the limited options he has available to him in Iraq. The lack of training and technology for doctors along with poverty and cultural dilemmas prevent many children from receiving surgery in the country. It’s hardships like these that affect Dr. Aso’s decision making every day.

One of his decisions that resonated with me concerned the fate of a three-month-old boy. His parents brought him to the office knowing he had a heart problem, but they needed Dr. Aso to examine and diagnose him. After a few seconds of doing the echocardiogram (an ultrasound of the heart), Dr. Aso’s whole demeanor changed instantly.

He explained to us that two of the little boy’s heart chambers were malformed and merged into a single chamber causing immense pressure to build in his heart. As the family and Dr. Aso discussed their options, the limitations became obvious. The surgery the child needs could be done in a town six hours away, but the family did not have the money to do this. On top of this, the next group of American non-profit surgeons who will perform local surgeries here does not arrive for another fifty days, which could be too late for the dying boy.

For a solid 10 minutes Dr. Aso did not say a word. He sat there, weighing the child’s options and deciding his fate. Imagine the immensity of this decision. Dr. Aso has basically been backed into a corner and told to make a decision on this child’s life. And so, he did. Waiting is the only option. He spoke to the parents, comforted them, signed the papers, and watched as the next patient walked in.

Dr. Aso often finds himself faced with difficult decisions, but with the options available to him he takes the initiative to make the best call for these children. These families are, in fact, some of the strongest people I have ever witnessed. They face impending tragedy while dealing with poverty and neglect. Sitting in Dr. Aso’s office, however, allowed me to see that real initiative can cause real change in the face of immense hardship.

People like Dr. Aso take this initiative as far as they can, and PLC hopes to offer opportunities for this initiative to be extended across the world. Whether it be through buying Klash from our Buy Shoes. Save Lives. program, supporting local healthcare through Remedy Mission, or creatively partnering with PLC to find new ways of providing these heart surgeries, you can also take the initiative to make a difference in childrens’ lives.

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