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)

Maddy Update!—Health On The Rise, Attitude Over A Cliff

December 22, 2012 by matt · Leave a Comment 

Remember how confindent I was that Maddy is the sweetest, most angelic child you could possibly meet?

I’m starting to think I was wrong.

He throws things, spits medicine at nurses, and will pinch most anyone who approaches his ICU bed. Of course, when a nurse pinched him back he only giggled hysterically. Maybe it’s just the drugs?

Granted, he did have his ribcage sawed apart, pried open, and then had his insides tinkered with. I’d probably be pretty grumpy if I were in his position. Teddy Grahams and M&M candies made him smile, so at least we know of some way to bribe a smile out of him.

The most important thing, though, is that he is being released to the step-down unit; he’ll be watched a bit longer and then—assuming there aren’t any surprises—he and his grandmother will go home.

Maddy’s newly-healed heart is a source of great joy for us. If you hadn’t already heard, he is our 300th lifesaving heart surgery to date, and we’re celebrating that this Christmas by stocking up on medical supplies.

You can help us do this. God-willing, by this time next year we’ll have saved another 300 children. That means we’ll double our total lives saved in just one year!

To help us make this massive leap forward for Iraqi kids, donate below:

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

Good News: Zahraa Was Wheeled Up To The Ward!

November 11, 2012 by matt · Leave a Comment 

Our girl Zahraa was sent up from the ICU to the ward today. She’s the first child from this mission to make it out of the ICU, and she’s almost certain to be the first to go home.

We’re now halfway through Remedy Mission XIII, and today is our midway break day. Last mission we visited Babylon and one of Saddam’s old palaces, but today the team is just relaxing around the hotel and getting some rest.

It’s this halfway point, though, when the ICU begins getting full, and we have to wait for children like Zahraa to get well enough to leave the ICU before the team performs more surgery. If there aren’t available beds, the children can’t be cared for after their heart is fixed. In short, please pray for the children who are recovering. Right now there are four in the ICU, and they’re all doing fairly well.

Thanks for your support and encouragement during these missions. You’ve helped us get so far, so keep tracking with us and we’ll have more updates for you when surgeries begin again tomorrow!

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Hussain Made It Through Surgery!

September 20, 2012 by matt · Leave a Comment 

He made it!

The operation went well. Other than that, there isn’t much to say. Now it’s just rest-time in the ICU.

Grab Your Backpack, Let’s Go—Zahraa Is Leaving The ICU!

February 20, 2012 by matt · Comments Off 

Good news! Zahraa (AKA the girl in the red coat) made it through surgery and is now in the ICU resting up.

In an effort to cheer her up, the ICU nurses gave her Dora the Explorer stickers and have been singing the theme song with her. It was a sweet moment, but now I can’t get that song out of my head!

Zahraa’s operation went so well that they are releasing her from the ICU soon. She will then spend a day or two in the ward, and after that she goes home!

I plan to visit the family’s hospital room after Zahraa is released, so come back tomorrow to hear more about this precious little girl and her trek toward recovery.

Come on, vamanos!

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After Only 26 Hours, Ali Is Out Of The ICU!

January 20, 2012 by Cody · Comments Off 

Does this look like a boy who just had an open heart surgery 26 hours ago? I didn’t think so!

I got a phone call from Ali early this morning telling me not to bother looking for him in the ICU anymore. I walked into the hospital to find him walking around in the ward!

Not only that, but he was already asking me when he can go home. Ali still really wants to be a doctor, so maybe one day he’ll understand how important this time is in the hospital.

But I love that he’s still a 12 year-old boy who can’t wait to go home and play soccer with his friends. At this rate, who knows, he could even be home by tomorrow!

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Breaking News: Ali Made It Through Surgery!

January 19, 2012 by Cody · Comments Off 

Ali was just brought out of the operating theater and into the ICU—with a mended heart!

The next 24 hours will be absolutely crucial for Ali, though. The operation was a complete success, but now we have to wait to see how his heart and the rest of his body will respond.

I ran into the ICU so I could take the above photo of Ali and show it to his mother. She was ecstatic to see her little boy!

Who knows what will happen next—Ali could be up walking around as soon as tomorrow!

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Little Amjed is The First One in and Out of Surgery!

January 12, 2012 by Cody · Comments Off 

Amjed is the first child to breeze through his heart operation and begin his recovery in the ICU today! Right now he has the entire ICU to himself but it’s about to get crowded fast. More are on their way!

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Alawi Moves Into The ICU Where He Awaits His Surgery

February 19, 2011 by Cody · Comments Off 

Alawi was taken into the Intensive Care Unit where he’s one step closer to receiving what we hope to be a fully corrective heart surgery!

Two things constantly amaze me during Remedy Missions.

The skill and care of the doctors and nurses and the bravery of these children.

Alawi’s one of the bravest I’ve met so far.

As Alawi was carried into the ICU and began treatments, you could tell that he felt uncomfortable but there was something in his eyes that made me think he knew that all of this was going to make him stronger.

Maybe it was the way he sat straight up and patiently waited as they began prepping him for surgery or the way he pushed the nurse’s hands away from the oxygen mask and held it over his mouth by himself, breathing in and out. As he took deep breathes of the oxygen coming from the mask his eyes would dart around and he would shift on the bed when something hurt or made him uncomfortable.

Other times his eyes would squint as his cheeks raised, revealing a grin under the clear mask.

I could only grin back as I told him I’d see him after he the doctors fix his heart.

Brave Alawi’s one step closer to the remedy and we can’t wait to see that grin again!

Be the first to see it tomorrow on our Facebook Page! Like it, post it, share it, and join the Remedy!

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Beautiful Zahran Passes Through ICU!

December 16, 2010 by Cody · Comments Off 

Zahran decided she didn’t want to waste any time in the ICU after surgery!

A life-saving shunt was placed near her heart to increase the blood flow to her lungs. Before the surgery, she would struggle to breathe and the only thing her mother could do was to lift her legs up to ease the tension on her heart.

Today, her mother was able to carry her around the ICU before she was taken to the hospital ward to be with Fatima, Ritha, and Anwar!’

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Hassan’s Surgery Was A Success!

December 13, 2010 by Cody · Comments Off 

Hassan’s surgery was a success!

When the doctors first looked at Hassan’s heart, he had multiple defects. When they were done with the operation, they had corrected each one of those defects and could only describe his heart as whole and complete!

Now Hassan is resting in the ICU, next to Ahmed, where the nurses continue to monitor how the rest of his body responds to his new and fully functioning heart.

Hassan’s wait for his surgery is finally over. Now all we’re waiting for is his return to his family.

 

Stay tuned…

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