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)

2013—A Year Of Saving 300 Children Begins Right Now!

January 10, 2013 by Jeremy · Leave a Comment 

"It always seems impossible until it's done."                               —Nelson Mandela

We ended 2012 celebrating the 300th surgery since our beginning in 2007! As we begin 2013, we are looking forward to 300 more before the end of the year.

This year we aim to double the number of children we have helped in just ⅕ of the time. We will also double the number of cities we are working in and double the amount of education and training we are able to provide—daunting goals. But, really, it doesn't seem too daunting after the mountains we've already scaled together.

There was a time when sending Iraqi Muslim children to Israel seemed like it would never work. Then there was the fatwa that called for our punishment and death for sending those kids to Israel.

Becoming a full-service, turn-key operation by sending children to Turkey once seemed impossible.

Our dream of hosting surgery teams inside Iraq to operate and train locals took years to realize and seemed more than a little crazy when the country was falling apart around us.

And even after we successfully brought these teams to cities all over the country, the idea of replicating it in an historically difficult city like Fallujah seemed even crazier.

But, with your help and with the help of our excellent partners, we've accomplished all of those things—and now we're headed back to Fallujah again.

Remedy Mission XV begins this week. The first step of our journey toward 300 more surgeries begins now!

To take this trip with us and to meet the children you're helping, follow along on the blog and on our Facebook page all week long. New stories every day!

We promise it'll be worth your while.

For the impossible,

Jeremy

Check Out 3 Ways You Can Save A Life This Christmas Season!

December 2, 2012 by Cody · Leave a Comment 

There are lots of ways to give this Christmas, but what better way than by helping save the life of a child?

You're reading this because you're already a making a difference—you've helped us save hundreds of lives in Iraq.

Here are three ways you can keep making a difference this Christmas:

#1: Put a tee under the tree: When you order our Remaking The World tee, you're helping fund a lifesaving heart surgery. Click here to place your order and give your friends a gift they won't forget!

#2: Party for life: Invite your friends over, crack open the eggnog, and save a life this Christmas. Each year parties are thrown to help raise awareness and money for heart surgeries in Iraq—talk about a great Christmas tradition!

You can also click here to throw an online party—a fundraising campaign to raise money with your friends. (When you start a campaign this month and let us know about it, we'll celebrate with you by mailing you a free Remaking The World tee!)

#3: Save a child, honor a friend: Give to a child in Iraq in honor of your friends and family this Christmas—just click here to donate give on behalf of a loved one. Then reply to this email and we'll send you a free PLC card to help you honor them!

So let the season begin, and join us in saving lives this Christmas!

Who’s Who In The ICU—The Respiratory Therapist

November 15, 2012 by matt · Leave a Comment 

Quiz time! What kinds of nurses and doctors does it take to pull off one of our Remedy Missions? Any guesses?

[Imaginary] you: “Uhhhh… a surgeon. And nurses. Aaand…others?”

That’s what I thought. You guys are insanely compassionate do-gooders who save lives, but we’ve failed you. We’ve spent so much time introducing you to the children you’re saving that we never introduced you to the people who are doing the saving!

But that’s about to change, starting today.

This is the first of a series where we’ll introduce you to the fantastic volunteer doctors and nurses who are saving lives and helping us eradicate The Backlog. And—since they come on most missions—we’re starting with the respiratory therapist, or ‘RT’ for short.

So I’ve asked Rachel Gulden, a friend and registered respiratory therapist, to share a bit about her work and what it entails:

After surgery, kids require a lot of care, and their breathing can be difficult to monitor and maintain. Rachel explains:

So there’s a quick introduction to the Respiratory Therapist, an important member of the medical teams taking care of these children. Considering you’re helping us provide plane tickets to these teams, we think it’s important for you to know what kind of care you’re providing.

Come back for our upcoming Remedy Mission XIV (that’s 14 for you non-Romans) and we’ll introduce you to another team member and their role. Thanks for reading!

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“Thanks For Saving My Son”—An Interview With An Iraqi Father

November 6, 2012 by matt · Leave a Comment 

Take 2 minutes to watch this interview with Noman, a university professor whose only son, Salam, was born with a life-threatening heart defect.

This is just one example of the difference you can make in the lives of Iraqi families! Please consider helping us save more like Salam by donating at the link below.

Help us save more children like Salam!

Our Partners:

Hikes Around Babylon, Hoops In Saddam’s Living Room

October 10, 2012 by matt · Leave a Comment 

We’re halfway through Remedy Mission XII, and that means something sweet: a day off.

On previous Remedy Missions, I used this day to catch up on big projects or even to grab a few extra hours of sleep. As you can probably imagine, these missions that you help us put on are intense.

We arrive at the hospital at 8am and usually stay there until 8 or 9 at night; if an operation goes longer, the team sometimes stays past midnight. After a week of this, a day off is essential for the team to refuel.

Many of these doctors and nurses use their vacation time to come on trips like this—that means they’re using their vacation to work harder than they would at home!

But the mid-mission trip is a good opportunity for the team to enjoy a little time away from the hospital, and for this mission we went to the ancient city of Babylon and Saddam’s vacated former palace.

Iraq, as I’m sure you know, is a place with a lot of history; The Cradle of Civilization, as it’s often called. And a lot of cool stuff that you’ve probably heard of was invented here: farming, cities, writing, and the wheel, just to name a few.

For me personally, it’s an interesting place because of the Biblical references. I grew up reading and hearing about Babylon, I had read the history—the words—and I knew the city existed, but visiting it and taking pictures of it with my own eyes made it so much more real—it offered me a reference point.

And that’s really my hope for you as you see photos and watch videos of these children you’re helping us save. I wish each of you could come to a Remedy Mission and to walk the halls of a hospital in-the-flesh, but I hope the hundreds of sweet, needy faces that we put in front of you will make this fact more and more real to you: The Backlog exists, and it isn’t ancient history.

At least not yet!

After an hour of trying to keep up with our tour guides, we piled into a van and drove up the hill to one of Saddam’s old palaces (pictured in the photo above behind the Lion). The photos below show a little of what we saw, including the basketball hoop in Saddam’s living room (presumably left by Coalition forces?).

Barbed wire blocking the stairway to the second floor of the palace.

A makeshift basketball hoop hung in the former sitting room of the palace.

The rebuilt ruins of Babylon as seen from Saddam’s palace window.

Ali, one of our security guards, with the ceiling of the living room behind him.

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A Peek Inside The O.R.—Watch Hussain’s Six Hour Surgery In Two Minutes!

September 23, 2012 by matt · Leave a Comment 

Have you ever wondered what a surgery actually looks like? Have you ever wanted to peek into the O.R. to see what it takes to save a child’s life?

Considering how much you’ve donated, started your own fundraisers, and cheered kids on over the past few years, I’d say you deserve a glimpse of all that you’re making possible.

So I got permission from the local surgeons to set my camera up outside the operating theatre—for 7 hours! Little Hussain’s operation had a few twists and turns, but sitting outside that door watching it all unfold was well worth it, and now you can do the same. Click the video above (or click here) to watch the lifesaving surgery you gave to Hussain!

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Would you like to make more surgeries like this possible? We’re going back to this same operating room in just a couple weeks, and we need your help saving more lives. Click here to donate directly, or go start your own fundraiser here—we love doing this alongside you!

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“You fell while riding your bike? That’s awesome!”

September 20, 2012 by matt · Leave a Comment 

Remember this little boy?

Last February, I met Nassir and his father, who agreed to help me make a video sharing their surgery-search. It was my first time to do something like this and, as I’m sure you can imagine, it was a highly emotional experience.

Nassir’s father drove all over Iraq looking for a solution to his son’s heart problem. Many could tell him that his son was going to die, yet none could do anything to help. It was, as he described it, “a bad dream.” His boy couldn’t even run, play soccer, or ride a bike.

Then, just a few days ago I rounded a hospital corner and Nassir and his father were standing there; they had come back for a check-up. After exchanging formalities, Nassir grinned and stuck his elbow in my face. “He hurt his arm riding his bike!” his father said, smiling. “That’s awesome!” I practically shouted back.

After we parted ways last February, Nassir went home, started racing other kids, and finally began getting the right kinds of hurts: scrapes and bruises, not a malformed heart or a pried-open chest.

They also showed me that they received the video we’d made together, and dad explained that he keeps it on his cell phone and shows anyone who will watch—“I tell them what you all did for me and my boy.”

I had several other things planned for that morning, but I couldn’t help dropping it all and sitting with Nassir’s father, re-watching that video on his phone, and listening as the cardiologist gave Nassir a clean bill of health. It was beautiful.

You and the rest of the Coalition made all this happen, and I hope you know how grateful Nassir, his father, and I are to you for that. You helped bring them out of their bad dream; you made it possible for us to celebrate scrapes!

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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…

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VIDEO: Our Third Update From The Operating Room In Najaf

September 16, 2012 by matt · Leave a Comment 

We’re back in Najaf for Remedy Mission XI, and the surgeries are well underway! Push play to hear our surgery count so far and how the local doctors are reacting to these fantastic training opportunities.

Keep watching to see updates of Hussain—we hear he’s in the hospital! This is the third of several operating room updates that we’ll be sending you, so keep watching and visit our Facebook page to see more photos from the hospital.

Our Partners:

“Thank You For Save Her, Sir!” Proud Parents Bring Back A Healthy, Adorable Sema

September 13, 2012 by matt · Leave a Comment 

Every mission I could swear I’d met the cutest child on the planet, they’re always one-upping each other. But today this little jewel was carried into the hospital break room, and I’m quite sure she takes the cake. And the crazy thing is, I’d already met her and didn’t realize it!

Her name is Sema (pronounced seh-mah), and she was the first arterial switch operation to be performed in Najaf last February. She was actually one of the first operations from Remedy Mission IX, and now she’s back for a post-op screening (just to make sure everything’s working alright).

Since our last encounter, Sema has learned how to smile, clap, eat on her own, and her skin is now a nice, life-like hue—as opposed to the blueberry tone she had before. Her parents were ecstatic and insisted that I take photos—a dream come true for any photographer!

After Sema had thoroughly won all of us over, her father grabbed Dr. Novick’s hand and, with a cracking voice and moist eyes, said, “Thank you for save her, sir!” His joy was a great reminder of why we do what we do, and it was a great reminder of how desperate these parents are. As you can imagine, the entire team was encouraged by their visit.

But Sema and her sweet smile wouldn’t be with us today if it weren’t for you—you gave money to make sure these Remedy Missions happen, and Sema is a testament to that. Would you consider giving again? Click here to donate and to help us save more children like Sema—we can’t do this without you!

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