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)

Saving Lives, Sans Surgery—Why Diagnostics Are So Important

April 24, 2013 by matt · Leave a Comment 

The girl in this picture was misdiagnosed as a baby.

Her family thought she needed surgery. They waited and worked, wondering if their daughter’s heart would give out.

As she gazed at the image of her heart beating, her father shared how hopeful they were that their daughter would get well.

Minutes later, he got his wish. After years of carrying around the wrong diagnosis, his little girl had a healthy, defect-free heart all along.

We’ve introduced you to a lot of sick, blue children over the past 5 years, but we haven’t always shared stories of already-healthy children. Thanks to highly trained cardiologists like Dr. Kirk, Iraqi children are receiving top-notch diagnostics testing in the form of preliminary echos, TEEs, and diagnostic catheterizations.

“We don’t do as many diagnostic caths in the US as we used to because we catch most heart disease early, before we have concerns about operability. Internationally, the situation is much different,” Dr. Kirk explained.

Over a span of # years, Dr. Kirk has screened hundreds of children across Iraq, and they’re often well beyond the ideal age for diagnosing a heart problem.

“Many of the children we see are being diagnosed or considered for surgery at a time which is much later than what we see in the west. The diagnostic cath tells us if a child is appropriate for a surgery or if a child would probably live longer if we didn’t do anything. There are many children who we think are inoperable because of their age, but we take them to cath and find they are indeed a good candidate for surgical repair. In this case we’ve probably added years to their lives by getting them repaired.”

In short, good diagnostics inform decisions, illuminate the situation for doctors and in-the-dark family members, and they save lives.

“The diagnostic cath isn’t as exciting as an interventional procedure to most, because, even if the news is favorable for surgery, another procedure is still needed.

If we can get away from focusing on what’s done today and look at what was learned today and what is best for the child, we realize we positively change the lives of children with a diagnostic cath.“

“Diagnostic caths either allow children to be repaired safely, or they prevent them from being harmed by surgery.”

Diagnostics take dollars—help us make it happen by donating below!

Our Partners:

Save The Children, Lose My Soul?—How I’ve Failed The Children I’m Working To Serve

April 18, 2013 by matt · 4 Comments 

Today I met a little girl named Israa.

That’s her up there with that soul-perceiving, Mona Lisa-gaze. You might be surprised to hear I wasn’t initially affected by her cute intensity (cutensity?). In retrospect, this was not the first time I’d simply snapped a photo of a child and moved on, emotion-free. Children that would have previously melted me on the inside had become… dare I say it—objects of charity.

Of course, I still want them to get well—I work for it every day—but the thrust of my compassion has taken a serious hit.

Attending six Remedy Missions, seeing waves of sick children held by desperate parents, and a dispiriting amount of post-operative death has taken a toll on my soul.

Our teams are now helping save more children then ever. But with every death, my emotional kevlar got a little thicker, and even the cutest kids like Israa couldn’t pierce it.

Is that really what we are aiming for? Hundreds of children whose lives are being saved by people who are barely affected as they serve? And, on a practical level, how can I do my job and connect you with these children if I’m not even connecting with them?

This is not the preemptive love we talk about, and, thankfully—while we do struggle at times—it isn’t a typical characteristic of our team.

But that’s just it—it’s a struggle. It has to be. Preemptive love takes risks for the sake of another. It stays vulnerable in the face of inevitable pain; it keeps compassion personal. And this applies to a lot more than just Iraqi children. Whether it’s your marriage, a friend struggling with addiction, or a tribe in the African bush, keeping compassion vulnerable takes work.

So back to my question: how do you continue to be vulnerable, emotionally present, and affected by those you’re seeking to love?

For my part, I’m committing to a few things: spending more time at the bedside of kids (without my camera), learning more kid-friendly Arabic phrases, and stuffing my bag with more play-things, like bubbles, Angry Birds and coloring books—and I want you to hold me to it!

And you? How do you keep from going numb, activating the defense mechanisms, or just giving up? What measures do you take?

Either comment below or email me—I’d love to hear from you!

Our Partners:

The Longest Lashes This Side of the Euphrates—Meet Hassin

November 18, 2012 by matt · Leave a Comment 

Hassin’s grandmother was pacing outside the lab, waiting for her grandson’s turn to be screened. From the look she gave the other families, they weren’t about to cut in front of her.

Having a friend there to translate, I walked over and introduced myself. I haven’t quite figured out what it is yet, but I think some combination of my height, dorky glasses, pasty skin, and ginormous camera make most Iraqis a little unsettled around me, sometimes even suspicious.

But she barely noticed me, she was so fixated on Hassin. When I commented on his eyelashes, she replied, “Yes, he’s really much too beautiful to be a boy, isn’t he?”

It wasn’t long before the cardiologist identified a hole in the lower part of Hassin’s heart, and the doctors immediately put him on the surgical list. Grandma kept lifting her hands and praying aloud for his safety.

The Iraqi doctor next to me explained that it was too difficult for the parents to even be in the room, so they entrusted their child to her. They’ll be getting good news, though, because Hassin’s surgery is as definite as things get here in Iraq!

Keep reading, we’ll have more of Hassin and his grandmother coming your way.

Our Partners:

Hussain Goes In For A Pre-Op Heart Screening

September 17, 2012 by matt · Leave a Comment 

Before surgery, the cardiologist has to take another look at Hussain’s heart to make sure he’s ready for surgery.

Thankfully, the results were good: he can receive an operation. Now he and his father just have to do the hardest work of all—wait. Dad barely let go of Hussain’s hand throughout this process. It’s been sweet to watch how close the two of them are. Please pray for Hussain’s healing, and that the operation would be a complete success.

Now we just wait for Hussain to be called in for the operation. More updates to come…

Our Partners:

We’re Making History—Three “Firsts” In One Week!

July 20, 2012 by Alicia · Leave a Comment 

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

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

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

This week was the first time the lab is used.

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

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

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

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

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

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

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

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

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

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

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

Our Partners:

Counting Kids: Researching Heart Defects in Dohuk

June 12, 2012 by Alicia · Leave a Comment 

Right off the bat, I got to be a part of something awesome here in Iraq.

I joined PLC’s groundbreaking research in the city of Dohuk in Iraqi Kurdistan. Many reports in recent years claim that there are more heart defects in Iraq than other countries in the Middle East. In Fallujah, news reports state 10 times more birth defects than the world average. However, these numbers are based on general observations, not a systematic study. Is it possible that doctors who only see sick children would think there are many more birth defects than there really are?

The best way to find out if there are more kids being born with broken hearts is to count all the children who are born, then see how many have heart defects are detected. That way, the number of healthy babies can be compared to the number of babies with defects to get an accurate ratio of sick to healthy babies. This is exactly what we did in the city of Dohuk.

Alongside long-time friend and partner of PLC, Dr. Kirk Milhoan and Dr. Serdar Pedawi, I was a part of a research team working to identify the heart defect “incidence” or number of new cases of babies born with heart defects out of all babies born over a certain time period. We set up camp at Azadi Teaching Hospital in Dohuk, and every child that was born came to us to be screened for heart defects.

This was done using an echocardiogram (ECHO) machine, which is similar to an ultrasound that allows pregnant mothers to see their babies. It provides a way to look at the heart from the outside, quickly and painlessly. All children born in Azadi Hospital during the week of the study had to be screened in order to obtain their birth certificate, so we were able to screen more than 180 kids!

Each individual encounter was very similar. The moms were usually too worn out from childbirth to bring the babies to us (understandably so!). It fell to the grandmothers and aunts to take care of the newborn while mom got some rest. It was beautiful to see how much love and care was shown to each baby we screened. They were all wrapped tightly in brightly colored clothes and tucked into what I can only describe as a fancy baby sleeping bag.

The children truly lived up to the phrase of “bundles of joy.” The pride and joy of family members was evident, but with it came the anxious fear that their baby could have something wrong with their heart. Immediately at the time of the screening we could tell the family the result of the ECHO.

Thankfully, the vast majority of children had completely normal hearts and their family was always relieved and ecstatic to hear the good news. But there were some babies who did indeed have heart defects. Some had leaky heart valves and others had holes in their heart. Assurance was given to the families that these were not immediately life-threatening emergencies, but that their baby needed to be checked again in a few weeks to see what kind of treatment would be needed to live a normal healthy life.

Dr. Serdar works full time as a Pediatric Cardiologist in Dohuk, and thus will take care of these babies directly. Research can sometimes be all about collecting numbers, but this research heavily emphasized providing practical medical care for those who were found to have heart defects.

It was an absolutely incredible experience to interact with the Kurdish and Arab families in Dohuk as well as to be a part of a first-ever scientific study. It was very fulfilling to contribute to the gathering of facts, which is a large part of why I’m pursuing a Master’s in Public Health. Having solid facts puts Preemptive Love Coalition that much closer to eradicating the backlog by treating kids who need lifesaving heart surgeries.

This research is the first step in providing information for the Kurdish Regional and Iraqi Central Government and any other organization that wants an answer to the question: how many Iraqi children are being born with heart defects?

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.

Rezhin Released to Return Home

November 30, 2008 by Jeremy · 262 Comments 

Dr. Tamir did a final echocardiogram for Rezhin and gave her the green light to return home. She and her mother were delighted with the news, and are counting the days together with her companion-in-surgery Tarza, below left.

There was still a bit of a ‘dark cloud’ on Rezhin’s countenance however as she was due to head to the dental surgeon this evening. The antibiotic prescribed for Rezhin by the dentist last week did fast work at knocking out the pain from her toothache caused by a bad cavity. This improvement gave her mother pause for considering whether they might wait until their return to Iraq to have the tooth treated, and she began indicating this choice to me yesterday. But before contacting the dentist to cancel the appointment, we wanted to be sure that her mother understood that the treatment here could save the tooth, and we were not certain if a dentist in their city could do so. After getting this news translated for Um Rezhin, her decision remained the same, and since the choice is hers to make, I contacted the dental surgeon to let him know we wouldn’t be coming. Only then did Rezhin become full of smiles, and she hasn’t stopped smiling through the evening.

Rezhin is a fearful girl, and reacts very strongly to even the thought of something being painful happening to her. Yet we’ve made sure her mother understands the importance of having the tooth treated and the implications on her heart if she doesn’t.

Excellent Echo Report, Fun With Beads

November 24, 2008 by Jeremy · 489 Comments 

Tarza got an excellent report after her echo, and although her mother was hoping to be able to leave after today, Dr. Tamir said Tarza should come back in one week for the final echocardiogram. We are thankful for this good report, and expect Tarza will be on schedule to go home early next week.

Excellent Echo Report, Now To The Dentist…

November 24, 2008 by Jeremy · Comments Off 

Rezhin began having a toothache last night, so I was concerned that the doctors know about it since tooth decay can affect the heart. In conversation while waiting for Rezhin to have her ECG, one of the volunteers mentioned that she had been a dentist before retiring, so I asked her to look at Rezhin’s tooth. It was clear there is a bad cavity there, but Rezhin misunderstood what was happening, and thought this volunteer was about to pull her tooth when she subsequently asked her to get on the examining table for the ECG. She began to cry and did not want to get on the table until we could convince her that this had only to do with her heart and not her tooth. We need to find a good dentist who can take Rezhin quickly and get this tooth out of the way so the new one can come in, and the possibility for infection will be gone. We are hoping to have someone donate their services for this need.

Rezhin had an excellent report from her echocardiogram and will need to come back in one week for her final echo. That means after just one more week she could be on her way home. This news brought a smile to both Rezhin’s and her mother’s faces.

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