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)

Joy That Demands Jogging—A Grandmother Runs To Her Grandson

December 30, 2012 by matt · Leave a Comment 

Maddy’s grandmother did something very unseemly when she saw her grandson: she ran to him.

In the Middle East, older and respected members of society almost never run, but Maddy’s grandmother couldn’t help her self—her boy was well!

After being smothered with kisses and hugs, our little 300th child lay down to rest for another day or two before going home. He’s almost out, and there doesn’t seem to be anything stopping him from growing up.

Thank you for giving life to this little boy!

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!

Happy Halloween From The ICU!

November 1, 2012 by matt · Leave a Comment 

I just wanted to drop a quick note saying ‘Happy Halloween’ and thanks to all of you who’ve helped the children pictured above (and the hundreds of others) continue living!

Zahraa’s Post-Op Echo Went Well—She’ll Be Heading Home Soon!

October 9, 2012 by matt · Leave a Comment 

Remember our little check-list?

Well Zahraa has checked off everything and she and her family are ready to go home! We’re going to have her stay in the hospital just a bit longer to make sure she’s fully fit to leave. We’ll have another update for you once she’s leaving the hospital.

Keep reading. We’ll have more for you soon…

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VIDEO: Another Update From The O.R.—Meet Two Amazing Cardiologists!

September 12, 2012 by matt · Leave a Comment 

We’re back in Najaf for Remedy Mission XI, and the surgeries are underway!

Click the play button to meet our kind cardiologists (volunteers w/ the International Children’s Heart Foundation), and to hear more about their work so far.

Several children have now received operations and are doing well—we’ll introduce you to some of then soon.

This is the second of several operating room updates that we’ll be sending you, so keep watching and keep an eye on our Facebook page to see more!

Our Partners:

VIDEO: Watch Hussain’s Excitement At Being Accepted To Surgery!

September 9, 2012 by Monique · Leave a Comment 

Last February, we introduced you to Hussain and his father.

Now we’re in the hospital again after months of waiting, eager to see Hussain and his father come walking through our door. You gave toward his surgery in a big way, and now we want to show you what the money and encouraging notes were for. We’ve got more arm-wrestling, air soccer, and high fives ready for him, but, more importantly, we’ve got a lifesaving medical team that is eager to save him!

The video above is footage from Hussain’s last visit, but we’ll have fresh footage for you very soon. Keep watching!

Our Partners:

Featured Partner: Angela Ferrara

August 25, 2012 by matt · Comments Off 

Each month, PLC receives generous donations from a variety of sponsors, and we love to highlight these people because they are an important part of the Coalition. Their donations are used to provide kids with heart surgeries and to launch programs like our upcoming Remedy Fellowship program!

Angela Ferrara is one of these incredible donors, and she was gracious enough to share a little about herself in an interview:

1) Would you tell us a little about yourself. Occupation? Interests? Passions? Aspirations?

I’m an adventurer and a dreamer who loves traveling, living in different cities in the U.S., and experiencing other cultures abroad. I also enjoy music, poetry, nature, contemplation, and a good cup of coffee. I currently live in Seattle where I work as a nanny and volunteer with the refugee community. For almost a decade I’ve had a passion to help those who cannot help themselves, and I’m working toward being able to focus on this goal vocationally.

2) And how did you hear about the Preemptive Love Coalition?

I heard about PLC through an acquaintance, Josh Gigliotti, who I met at Cedarville University. I saw his Facebook posts while he was in Iraq and became extremely interested in the work PLC was doing there.

3) What motivates you toward compassion for Iraqi children?

Learning about what PLC does for children in Iraq has made me realize how vital their work is. It’s heartbreaking thinking about the condition these kids are in, but I am filled with hope when I read PLC’s blog and see the photos of the children post-surgery.

4) Is there anything you would like to tell the rest of the Coalition? Any rally cries, encouragements, or challenges?

PLC’s love and dedication for the children and people of Iraq is such a beautiful and tangible expression of the heart of God, providing hope for the hopeless. Let’s love with them!

###

We’re so thankful to Angela for her commitment to saving the children of Iraq! Stick with us for this next week of blogging goodness; we’ve got our eleventh Remedy Mission and our second mission to the holy city of Najaf coming up—great things are ahead!

Mohammed’s Still Smiling And Is One Day Closer To His Remedy!

July 3, 2011 by Alex · 2 Comments 

My friend Mohammed is back!

Mohammed made me feel so welcomed when we first arrived, and I’ve missed him as he’s been out of the hospital these last few days. But now he’s back and brightening everyone’s day with his contagious smile!

Besides seeing my new friend again, something else has me smiling all day: hearing that Mohammed is scheduled for surgery this week!

Each kid we meet here captures our hearts, but there’s something extra special about hearing how the remedy is coming to a little boy or girl you have a personal connection with. I can’t even imagine how special the feeling of hope and excitement must be for each of these kids, their parents, families, friends, and communities all over Iraq.

Thank you for bringing that feeling of hope to Iraq, and to my little friend Mohammed!

He’s one day closer to his remedy. Get ready!

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Mohammad Fwad’s Surgery Post-Poned until Monday; We Plan Future Remedy Missions to Eradicate the Backlog

August 22, 2010 by Cody · Comments Off 

On my taxi ride home tonight I thought through what needed to end up on our blog before we ended our day. Some days that’s an easy question to answer because of what happened, whether it was multiple surgeries to celebrate, or the full recovery of yet another child. Today, both of those things happened and we’re thrilled about it! But what made today hard was when we heard that Mohammed’s surgery was pushed back yet another day.

Mohammed, his family, and all of us expected his surgery to take place last Friday. Unfortunately, we couldn’t know how long each surgery would last and we couldn’t anticipate the local shortage of blood products; the limited supply of certain medical instruments; or an influx of emergency cases that have come seeking Remedy. In any case, Mohammed’s surgery was pushed to Saturday. Then it was pushed to Sunday. It’s 10:30 PM on Sunday night and Mohammed must wait yet another day to be admitted to surgery.

Mohammed is not being overlooked. In fact, it’s because our team from the International Children’s Heart Foundation refuses to overlook any child or settle for anything less than the best that certain children have required more time and attention than originally planned. It’s because of this team that each child has received a near perfect correction and followthrough each day, no matter what the expense and no matter how long it takes.

But that doesn’t make it any easier for Mohammed’s mother and father as they grow weary of waiting. It’s certainly not easy for two year old Mohammed who wasn’t allowed to eat or drink for 12 hours today as his surgery was delayed and then post-poned.

“When will you save my son?” I heard it repeatedly today. It wasn’t out of anger or bitterness, it was simply a mother who cares so deeply and longs for the healing of her son. If I was in her position, I doubt I would respond with such grace; especially if the person across from me couldn’t give an answer.

Mohammed is scheduled to receive surgery tomorrow (Monday), but even when he receives his surgery there are still so many more that are waiting and hoping for another Remedy Mission. Even if we were able to operate on 50 children this week, we would still have to turn people away at the door. If we operated on 1,000 kids, more would still have to wait.

It breaks our hearts a thousand times over, but at the same time it makes our hearts stronger. It strengthens our resolve and lights a fire within us to continue to do what we’re doing. We refuse to be content in a country that has a backlog of thousands of children who are in desperate need of heart surgery. We refuse to sit by and let them die. We can not accept the fact that there isn’t enough training among Iraqi doctors to save these children.

We believe that these Remedy Missions are the missing link we’ve been reaching for these last three years. And we believe we can work together with the people of Iraq and with the rest of the world to train Iraqi surgeons to care for their own so that we do not just address the backlog of Iraqi children waiting for surgery as we know it today, but rather work toward serving every child from this point forward who is born with a heart defect. We can help empower and strengthen local doctors and nurses and this first Remedy Mission makes it clear that YOU can continue to make this a reality.

Kids like Mohammed are the reason why we are already dreaming and beginning to plan future Remedy Missions across Iraq. And they are the reason we are raising money for not just one more Remedy Mission, but for dozens in the coming years.

So we are fighting for Mohammed and his parents today and we will fight for another child and his family the next day and we plan to keep on fighting until every Iraqi family has access to the lifesaving heart surgeries that their children need to live.

Will you donate below to make these parents’ beautiful dreams a reality?

With you,

Remedy Missions are international pediatric heart surgery teams that we bring to Iraq to to perform lifesaving heart surgeries and develop the infrastructure for the future. If you’re on Twitter this week be sure to use the #Remedy or #RemedyMission hashtag to describe all the good news coming out of Iraq this week via @preemptivelove and @babyheart_org. If you’re on Facebook, “Share” this story with the button below.

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Photo of the Day

June 8, 2010 by Lydia · Comments Off 

This is Bala. She is a completely healthy 13 year old who loves life! While PLC actively works to eradicate the waiting list of Iraqi children suffering from heart disease we’re also working in and among local Iraqi communities to promote messages of love and peace.

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