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)

Mohammad Fwad’s Surgery Post-Poned until Monday; We Plan Future Remedy Missions to Eradicate the Backlog

August 22, 2010 by Cody · Comments Off 

On my taxi ride home tonight I thought through what needed to end up on our blog before we ended our day. Some days that’s an easy question to answer because of what happened, whether it was multiple surgeries to celebrate, or the full recovery of yet another child. Today, both of those things happened and we’re thrilled about it! But what made today hard was when we heard that Mohammed’s surgery was pushed back yet another day.

Mohammed, his family, and all of us expected his surgery to take place last Friday. Unfortunately, we couldn’t know how long each surgery would last and we couldn’t anticipate the local shortage of blood products; the limited supply of certain medical instruments; or an influx of emergency cases that have come seeking Remedy. In any case, Mohammed’s surgery was pushed to Saturday. Then it was pushed to Sunday. It’s 10:30 PM on Sunday night and Mohammed must wait yet another day to be admitted to surgery.

Mohammed is not being overlooked. In fact, it’s because our team from the International Children’s Heart Foundation refuses to overlook any child or settle for anything less than the best that certain children have required more time and attention than originally planned. It’s because of this team that each child has received a near perfect correction and followthrough each day, no matter what the expense and no matter how long it takes.

But that doesn’t make it any easier for Mohammed’s mother and father as they grow weary of waiting. It’s certainly not easy for two year old Mohammed who wasn’t allowed to eat or drink for 12 hours today as his surgery was delayed and then post-poned.

“When will you save my son?” I heard it repeatedly today. It wasn’t out of anger or bitterness, it was simply a mother who cares so deeply and longs for the healing of her son. If I was in her position, I doubt I would respond with such grace; especially if the person across from me couldn’t give an answer.

Mohammed is scheduled to receive surgery tomorrow (Monday), but even when he receives his surgery there are still so many more that are waiting and hoping for another Remedy Mission. Even if we were able to operate on 50 children this week, we would still have to turn people away at the door. If we operated on 1,000 kids, more would still have to wait.

It breaks our hearts a thousand times over, but at the same time it makes our hearts stronger. It strengthens our resolve and lights a fire within us to continue to do what we’re doing. We refuse to be content in a country that has a backlog of thousands of children who are in desperate need of heart surgery. We refuse to sit by and let them die. We can not accept the fact that there isn’t enough training among Iraqi doctors to save these children.

We believe that these Remedy Missions are the missing link we’ve been reaching for these last three years. And we believe we can work together with the people of Iraq and with the rest of the world to train Iraqi surgeons to care for their own so that we do not just address the backlog of Iraqi children waiting for surgery as we know it today, but rather work toward serving every child from this point forward who is born with a heart defect. We can help empower and strengthen local doctors and nurses and this first Remedy Mission makes it clear that YOU can continue to make this a reality.

Kids like Mohammed are the reason why we are already dreaming and beginning to plan future Remedy Missions across Iraq. And they are the reason we are raising money for not just one more Remedy Mission, but for dozens in the coming years.

So we are fighting for Mohammed and his parents today and we will fight for another child and his family the next day and we plan to keep on fighting until every Iraqi family has access to the lifesaving heart surgeries that their children need to live.

Will you donate below to make these parents’ beautiful dreams a reality?

With you,

Remedy Missions are international pediatric heart surgery teams that we bring to Iraq to to perform lifesaving heart surgeries and develop the infrastructure for the future. If you’re on Twitter this week be sure to use the #Remedy or #RemedyMission hashtag to describe all the good news coming out of Iraq this week via @preemptivelove and @babyheart_org. If you’re on Facebook, “Share” this story with the button below.

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American Donor & Volunteer Shares From Front Lines of our Work in Iraq & Turkey

August 6, 2010 by Timothy · Comments Off 

Have you ever observed something that made you feel just a little more alive than you did the second before? The senses sharpen, everything else around you stops, and it seems as if the state of your very existence could hinge upon your understanding of that precise moment. Life all of a sudden becomes more valuable and hope of something unintelligible, unexplainable and far off fills your being from deep within.

That is how I felt when I dodged a father running to see his daughter’s doctor following the completion of her open heart surgery. His wait to see his daughter was not quite over, yet as I dodged out of his way it was obvious that any news was the most important thing in the world to a helpless father who could do nothing to rescue his daughter from an unseen foe.

There were honestly a few moments that rivaled this one during my short three days spent at Anadolu Medical Center with the Preemptive Love Coalition. When the constant issue at hand is that of life and death, the meaning of both is unavoidable. Although I’ve followed and supported PLC for three years now, the personal interaction with the children heading to surgery and their parents was a gift I was not quite prepared for. As I sat outside at the hospital coffee shop with Nivar’s father, still waiting to see his daughter for the first time since surgery, I could feel the anxiety and helplessness surrounding him and was reminded of the gift of loved ones. Every healed heart at Anadolu Medical Center is a child saved, a future restored and also a family preserved.

One of the greatest blessings in working with, giving to and supporting an organization like PLC is the knowledge that what you are doing is truly meaningful. And let me tell you partners, supporters, donors and friends of PLC, your investments and partnerships are truly worthwhile! Your efforts and funds go directly into saving childrens lives, preserving families and renewing futures. From all over the world, you are affecting lives of real people for the better. I’ve seen it. And these people are thankful.

One particular issue that was brought to light during my week with my friends at PLC was that ethnic struggles do not have to result in war, racism or death. Addressing ethnic and religious tensions can also result in life, in reconciliation, in hope for the future. For every political struggle that takes place in order to get a Iraqi child to a successful surgery in Turkey, there is also a celebration of life, a reconciliation of enemies, and a hope of a child’s future reborn.

Finally, it seems the shared response from all parties involved is one of doxology, “thanks be to God.” That is truly amazing, and it is something I will always choose to be behind.

This little boy, Yahya, still needs a few thousand dollars to cover the costs of surgery and travel from Iraq to Istanbul so he can experience the same life-change you’ve given Nivar. To take Yahya out of line and get him to Istanbul for surgery, please enter the amount of your choice below and click “Donate Now!”.

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

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5 WAYS TO SAVE A LIFE THIS OCTOBER!

October 21, 2009 by Cody · Comments Off 

5 WAYS TO SAVE A LIFE THIS OCTOBER!

1. Stuff home-made flyers about the Preemptive Love Coalition in your Halloween costume and drop them off at each house as you go trick-or-treatin’!

2. Throw a Halloween party and ask your friends to bring money to donate to Honya and Danar’s heart surgery this November!

3. Instead of buying a candy bar for a dollar – tell each trick-or-treater that you’re donating a dollar to the Preemptive Love Coalition for each trick-or-treater that shows up to your door!  (extra points for taking a picture of the reaction on their face when you tell them that)

4. Sell your candy to your little brother or sister and use that money to put Honya and Danar on a plane to receive life saving heart surgery!

5. Enter an amount below to save a life right NOW!

Little Honya is next child from Iraq in line for life-saving heart surgery. The chambers of her heart are enlarged and she has a huge hole in a very critical place. We want to fly her to Istanbul, Turkey on November 8, 2009. But before she can go, we need to cover the cost of airfare for her and her mother ($405). Donation:

Danar is is your average three year old boy… except that he was recently hospitalized after turning blue while playing with his brother from a lack of oxygen in his blood. In other kids, we’ve seen this lead to brain damage. Danar has dodged that thus far. We still require roundtrip airfare ($822) for two before sending him in November. But this surgery is likely to do more than merely help Danar avoid brain damage… we can actually set Danar free to live! Donation:

PLC is Tax-Exempt!

April 13, 2009 by Jeremy · 637 Comments 

Just in time for tax season, the IRS has certified the Preemptive Love Coalition as a tax-exempt public charity!

That means that anything you give to PLC (i.e., not merchandise purchases) is fully tax-deductible! (This even applies retroactively to anything you’ve given all the way back to February 15, 2008.)

It’s cool to be a 501(c)(3)!

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:

1. Mohammed was born with a broken heart.
2. Mohammed died from a broken heart.
3. 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.

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