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)

Six Places We’re Visiting On Our Upcoming American Tour—Will We See You?

February 14, 2013 by matt · Leave a Comment 

I recently sat across a table from a white, middle-class, 20-something American man from Texas and it was just so… wonderful.

No, I wasn’t having tea with a mirror.

When we aren’t helping Fallujan babies get heart operations, we’re constantly encouraging you to engage ‘the other,’ to find someone radically different from yourself—preferably someone you would deem an ‘enemy’—and to connect with them. You get extra points for learning from them, and even more points for loving them when they treat you poorly.

But there is something really sweet about connecting and refreshing with like-minded people, and that’s why our recent trips across the United States have felt like a breath of fresh air. We speak the same language, we agree that Mayo on fries is nasty, and we share a common cultural heritage. Not to mention you guys teach us so much!

The eyes-wide-open passion of the students and faculty at Cedarville University, Bryan College, Taylor University, Calvin College, and Pepperdine University blew us away; it gave us hope.

So, to all the individuals and institutions who have hosted us in recent days: THANK YOU! Your role in the Coalition is invaluable—you’re saving lives in Iraq, and you’re certainly making ours better.

We’re headed back to the States this month for a series of speaking engagements, and we’d love to see you! Check the listing below to see if we’ll be in your area, or leave us a comment/send me an email if you’d like to host one of our staff for a dialogue about enemy-love, peacemaking, or our development work in Iraq.

    Houston Baptist University – February 19 – Houston

    The Justice Conference – February 22+23 – Philadelphia, Pennsylvania

    The Loft Church – February 23-24 – The Woodlands, Texas

    Ecclesia Church – February 24 – Houston, Texas

    Eastgate Community Church – February 25 – Cincinnati, Ohio

    Cedarville University – February 27 – Cedarville, Ohio

Photo Credit: Calvin College

His Heart Condition is Threatening His Life – Have You Met Alawi?

February 18, 2011 by Jeremy · 633 Comments 

You need to.

This just may be the cutest and most adorable boy in Iraq.

Alawi Hussein is just under three and a half years old and he was born with a congenital heart defect.

At 9 months old, instead of taking bets on what his first word was going to be, his parents were coping with the devastating news that Alawi had a heart problem. It was a heart problem, like most heart problems in Iraq, that could only be fixed outside of Iraq.

The list of countries that could help him was long.

Iran.

Turkey.

Jordan.

India.

America.

Basically – many other countries except the one he was born in.

While the list of opportunities was long, the list of actual possibilities for Alawi was short.

Hearing about all the doctors overseas that can heal your son is simply cruel if you don’t have the money – or even a passport – to pursue the option.

His family had to learn to enjoy the time they had with Alawi and just hope for a remedy the doctors might have somehow missed.

That surprise came this month when they were called by their local cardiologist here in southern Iraq and told that Alawi no longer needs to go overseas to be saved, because of a team of doctors and nurses that was being brought in to save his life at the hospital just fifteen minutes from their home

It was thirty-two months later than they were hoping but remedy finally came to southern Iraq.

We still hope that Alawi’s family will visit foreign countries someday, but not as last chance medical tourists!

You are the Remedy.

You bring in medical teams every time you give. Our medical teams teach Iraqi doctors and nurses. Our medical teams save lives. So Iraqi doctors and nurses learn how to save lives. Our medical team goes home. The Iraqi’s keep saving lives.

It’s one beautiful domino affect!

We hope we can save Alawi’s life this week… and not just because he’s one of the cutest boys in Iraq! Follow Alawi’s story this week on the blog and on our Facebook page (<-- link) to see what comes next...

Our Partners

From Hollywood to Detroit to talk with a Leading Muslim Cleric about Development in Iraq

October 5, 2010 by Cody · 3 Comments 

Photo by Just Us 3

In Los Angeles last week we met three brothers who had given up their birthday money to help save the life of a child in Iraq. All three brothers are under the age of five, which makes them the youngest heart menders we’ve met on the tour!

From their house I hopped on a plane that took me to Dearborn, Michigan outside of Detroit to spend an afternoon with Imam Qazwini. Imam Qazwini is the leader of the Muslim community in Dearborn where he preaches and leads times of prayer in the largest mosque in America. He is also widely held to be the leading voice for Muslims in North America while also advocating tirelessly for reconciliation, tolerance, and peace.

He was born in Iraq but spent 32 years as a refugee after Saddam Hussein killed his grandfather along with 15 other family members for being Shiite. During my time with Imam Qazwini, we shared stories and drank tea as he told me about his family and his love for Iraq. But what impacted me the most was his vision for the future.

This man believes in peace. This man believes in reconciliation. This man is a heartmender.

He’s committed to a future for Iraq that doesn’t involve bombs, chemicals, or racism. To my surprise, he and his ayatollah father (who is still in Iraq) are both actively committed to a future where a backlog of 20-30,000 children waiting for lifesaving heart surgery is a thing of the past.

As I finished my tea with Imam Qazwini I thought about those three boys who had given their birthday money to save a life. What does a 2-year-old have to do with someone like Imam Qazwini? They both believe they can make a difference. They’re both heartmenders.

Today I thanked GOD for Imam Qazwini in Dearborn and for those three boys in Los Angeles along with all those out there who believe in tomorrow.

What are you up to today to mend hearts in your community or in Iraq? Let us know on Facebook or via Twitter (both below).

With You,

Do YOU Have What It Takes?

December 9, 2009 by Cody · 19 Comments 

“This is all it takes?”

That was our response when we received some heart valves in the mail this past week. This tiny piece? This is all it takes to turn a little boy gasping for breath into a soccer player? This is all it takes to turn a little girl who has to be carried to school into a girl who laughs as she races her friends to the playground for the first time? To turn a dying heart into a thriving heart?

This is it. (Plus a couple decades of practice, amazing medical facilities, and a stellar surgical and support team!).

Now, this ACTION TEE below is all it takes to put a life-saving, child-transforming, heart-mending valve into the hands of our doctors! Order our NEW Heartmender Action Tee TODAY and you’ll put a gift under the tree that literally SAVES LIVES with profits from the shirt covering the costs of these heart valves!

This is all it takes. Do you have it?

DID YOU GET YOUR SHIRT? CHRISTMAS BLOG SPECIAL — 20% OFF! PLEASE SELECT YOUR SIZE Small Medium Large X Large

NEW Shirts Just For YOU!

December 4, 2009 by Cody · 5 Comments 

Dear Peacemakers & Heartmenders –

As 2009 draws to a close you’ve used your voice, resources, and passion to provide 21 heart surgeries for children in Iraq! Twenty one boys and girls, 42 parents, and countless communities across Iraq and the world have been affected by your generosity this year alone!

But here’s another way you can mend hearts and make peace this Christmas! You’re the first to see our brand new Heartmender & Peacemaker tees! Wipe the drool off your keyboard, get out your digital shopping cart and give your family and friends a t-shirt that literally mends hearts and makes peace!

The Heartmender Tee

Put our yellow Heartmender Tee under the tree this year and 100% of the profit pays for heart valves and patches–the pieces that literally turn a dying heart into a thriving heart!

The Peacemaker Tee

Stuff our olive Peacemaker Tee into a stocking this Christmas and 100% of the profit goes directly to our Followthrough Program, the program that creates cooperation and peacemaking opportunities between communities at odds. In this shirt, your family and friends can know that you’ve brought together Arabs, Kurds, Turks, and Westerners who are breaking down the barriers to peace in Iraq and throughout the world with life-saving heart surgeries.

CHRISTMAS SALE: Heartmender Tee

These dear Iraqi kids are often born with holes in their hearts that need patching and valves that need replacing. And it’s outrageously expensive! Buy this tee and stand in the hole between what could be and what should be.

Price: $19.99
Size:

Small Medium Large X Large 2X Large

Filed Under: Featured, News, Peacemaking, Store Tagged: heartmender, peacemaker, tshirt

Shy Yet Brave In Initial Tests

January 6, 2008 by Jeremy · 1 Comment 

A shy Tarza and her mother began the admissions process today for her heart surgery. Even though she is beginning to warm up to those of us on staff, she is still very quiet and shy. Because of this, I rather expected her to be fearful of the tests which had to be done today prior to her admission. What a surprise that she was such a trooper when it came her turn for the dreaded blood test!  She only made a small whimper when the needle was inserted, and was very brave the rest of the time for every test.

The doctor found in the echo that Tarza has an ASD, which can be repaired by a simple and short heart surgery (relatively speaking of course!) It is hoped that her surgery can be scheduled soon, and after the surgical team meets on Sunday we should have a better idea about just how soon. Naturally all of us hope they do not have to endure a long wait to get the treatment they came for.

On Sunday Tarza and her mother will return to the hospital to be checked after the standard test for tuberculosis.  One father was a great help to them and us at the hospital by translating and explaining what to expect, and another father has been a great help here at the house.

Filed Under: Heart Surgery, Our Kids, Surgery Updates, Tarza Tagged: ASD, blood test, BSSL, Heart Surgery, heartmender, hope, Jeremy Courtney, Tarza, TB, translator