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)

Hussain Is Headed To Surgery!

September 19, 2012 by matt · Leave a Comment 

As they were waiting for surgery, I snagged Hussain and his dad for a quick photo shoot in the adjacent operating room. His father is nervous—he keeps grabbing his son and squeezing him. Hussain is normally too hyper to be held down, but he just sat there and let his dad hold him. I’m sure he could tell something was about to happen.

For me, this is the most unsettling time of the entire surgical process. It’s not while they’re in the O.R. or when they’re in critical condition in the ICU, it’s now. It’s the waiting. Once the child is on the table there’s no going back, but you can see the uncertainty in Hussain’s father’s eyes as he sits there wondering whether or not to go through with it.

If I’m nervous, I can’t even begin to imagine how he must feel.

As I sat with them, I attempted to exchange emails with Hussain’s father in order to send him the photos after the mission. He didn’t know what email was; a nearby nurse had to explain it to him. I tried to imagine how his father could not know about email and still be willing to trust his child to the doctors with all their medical technology and know-how. It must have taken incredible faith on his part to let Hussain climb up onto that operating table.

But thankfully, we have a phenomenal team with us this mission, and Hussain’s case isn’t overly complex. That doesn’t mean it’s a guarantee, but it’s at least comforting. Thanks for sticking with Hussain and his sweet father up to this point.

We’ll have more surgery updates for you in a few hours—keep reading!

Our Partners:

It’s The Day Before Parzheen’s Surgery And She Can’t Wait To Run!

March 2, 2011 by Cody · 2 Comments 

Meet Parzheen.

She’s four and a half years old and was born with a congenital heart defect that wasn’t discovered until she was three years old.

If you ran into this beautiful girl outside of the hospital, you probably wouldn’t even notice that she had a heart defect.

It wouldn’t be until you saw her run, play, and laugh that you would notice how quickly she became tired. A year and a half from now you would notice it when she wouldn’t be able to walk to school with the rest of the children. When she’s at school, you would notice her not having the strength to stay awake in class.

But tomorrow Parzheen is being given the surgery that’s going to change all of that!

It will let her run to school.

It will let her interact with her classmates at school.

It will give her the chance to try out that jump rope that she’s never had the strength to conquer.

It will save her life.

Parzheen goes into surgery in the next few hours.

Stay with us as we follow her story!
If you’re on Twitter this week be sure to use the #RemedyMission hashtag to describe all the good news coming out of Iraq this week via @preemptivelove.
With help from our friends:

Headed Home While Remedy Continues To Gain Momentum

December 22, 2010 by Cody · Comments Off 

At the end of the first Remedy Mission in Southern Iraq we served 22 families, corrected 45 heart defects and gave a collective 7,000 hours of training to more than 50 local doctors and nurses!

Kids conquered heart disease together, families built new networks of friendships, doctors gained mentors, nurses gathered inspiration, and a foundation was laid for what might someday become a fully functional, locally-run pediatric cardiac surgery center.

Thanks to YOU, the momentum has continued from our first Remedy Mission in Sulaymaniyah last August to the latest mission in Nasiriyah. As we get ready for 2011, both Sulaymaniyah and Nasariyah are preparing for 8 more Remedy Missions this next year!

The growing coalition of partners that continue to bring Remedy include all of us at PLC, our freinds at the International Children’s Heart Foundation, Living Light International, Kurdistan Save the Children, both the Iraqi and Kurdish governments along with local governments and ministries of health, and you!

Without your support, there would be no remedies like what we’re witnessing.

With your support, this will only be the beginning!

With each story that’s told through these missions, a growing community is being drawn to the people of Iraq. As a community, we’re not only beginning to grow in our understanding and love but we’re tangibly waging peace in both our local communities and in communities throughout the Middle East.

It’s a pleasure to be standing alongside you. Let’s press on!

Our Partners:

The Day Shams Received A Remedy and The Day She Died

December 19, 2010 by Cody · Comments Off 

This week, little five year old Shams Hadi died during her 12 hour operation. Shams was born with a combination of three congenital heart defects. By themselves, those three defects aren’t unusual among children here but none of the doctors or cardiologists had ever seen the combination of all three in one child.

In a developed country, Shams should have received surgery at three months. Her five year wait had simply done too much damage to her heart and lungs and by the time she saw the doctors that could cure her, it was too late.

The doctors were astonished she had lived this long.

But this week there was one last chance to fight for her life.

Before Remedy began, I thought about what I would write in this post. I came into these two weeks knowing that lives would be saved but also facing the sober reality that it might already be too late for some of the children we’ve met.

Even though these surgeries are just in time for some and too late for others, every one of these children is having their story rewritten.

Their stories all began with them being born in a country that didn’t have the doctors or hospitals that could save them from their disease. While there were remedies, they are all overseas and out of reach for all of them. Before now, these stories were ending with them still dying without any options.

Now, stories are being rewritten so that children in the north and in the south are beginning to see the remedy for the first time.

For many, it came just in time. For a few, their story ends with them not alone but instead surrounded by an entire team of doctors and nurses who gave it everything they had to save their life.

Shams’ story ended that way. It ended with her family being surrounded by a community who had grown to love them deeply.

Bringing remedy to Iraq doesn’t mean we make heart disease a thing of the past. It means that every child born with heart disease has access to the care that they need to fight it.

And that’s why, during days like today, we don’t lose hope. That’s why we honor Shams and her family by not giving up the hope that soon no Iraqi children will have to wait as long as she did to be treated.

Thanks for standing alongside us, in the joy and in the pain.

Thank you for continuing to rewrite the stories of children and families all across Iraq.

Our Partners:

Family Advocate Connecting with a Two-year-old Waiting for Heart Surgery

July 11, 2010 by Sophia · Comments Off 

On a house visit last week I noticed Chro’s tiny bright-pink fingernails and toenails as she sat squeamishly on her father’s lap. Chro is one of five children going to surgery on July 18.

Her father is a policeman, a civil servant in charge of protecting their village; but right now he is focused on protecting his little girl by sending her to surgery. At 2 years old, Chro is battling the heart disease inside her chest.

As I sat with her family on the knit rugs that lined their living room floor, Chro’s eyes anxiously looked around. She started to whimper a faint cry because her lungs can hardly provide enough oxygen for the deep breaths that are required to shed many tears.

She was scared.

I could only imagine what might be going through Chro’s head. She is a little girl, who will soon be getting on a plane and flying to a foreign country only to have her small heart cut open and restored. Can she possibly grasp the magnitude of lifesaving heart surgery? I cannot possibly understand what it feels like to be a scared two-year-old with shortness of breath and probing doctors.

After I asked Chro’s family about her likes, her mother, a sturdy Kurdish woman with a protruding pregnant belly, smiled and said, “Dolls, lollipops and ice cream.”

I realized that Chro is a normal little girl. In spite of facing a disease that threatens to take her life, she is a little girl who likes lollipops, rainbows, baby dolls and bright pink. I think we have more in common than I first thought.

Photo of the Day

July 4, 2010 by Lydia · Comments Off 

Dr. Aso screens a child for heart disease at the children’s hospital here in Iraq. Dr. Aso is the leading pediatric cardiologist in Kurdistan and works closely with PLC! He’ll be a major part of Remedy next month!

Photo of the Day

June 25, 2010 by Lydia · Comments Off 

During a home visit this week, Danar and his brother fight for the camera’s attention. Danar had surgery a few months ago and has recovered so well. He loves to run and play, these guys are so much fun to watch!

Photo of the Day

June 24, 2010 by Lydia · Comments Off 

Little Honya peeks out from behind her mother in the kitchen, so cute! This is from our most recent home visit with Honya, she is so healthy and happy!

Photo of the Day

June 14, 2010 by Lydia · Comments Off 

A local pharmacist stands behind the counter of her pharmacy here in Iraq.

Photo of the Day

June 12, 2010 by Lydia · Comments Off 

The summer interns visited a children’s hospital in the area to talk with Dr. Aso, who will be part of the Remedy mission this summer. Dr. Aso is a hugely important pediatric cardiologist for all the children of Iraq!

Next Page »