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)

50 Family Focus + Two Teams of Turks = 90 Kids in 2010

December 30, 2009 by Jeremy · 520 Comments 

To date, we’ve served 45 children by offering families a hand-up in their efforts to save their own children’s lives. We’ve seen poor families work harder and smarter to take part in our family participation program to fund a portion of their child’s surgery.

As we enter 2010 we plan to up the ante and send 50 children out to surgery in Istanbul, Turkey at the Anadolu Medical Center. We hope to do this by sending four children every month. (January’s group is already set and February and March are filling up quickly!). The price tag for these surgeries will be roughly $500,00 – with at least 50% of that amount coming from local Iraqi sources!

Additionally, we hope to make 2010 a year of investing in local infrastructure by creating forums for the exchange of knowledge, skills, and experience by bringing in foreign experts to operate and train local cardiologists, surgeons, and nurses to hasten the day of more local solutions to local problems in Iraq.

We aim to bring 2 surgical missions into Iraq this year to serve 40 additional children in local hospitals by training local surgeons, cardiologists, and nurses. We have already begun screening candidate hospitals, cardiologists, and surgeons to ensure our investments go to the most disciplined and visionary practitioners.

Kids like Honya, Vary, or Mohammad have made 2009 an amazing year. Does 90 kids mean that 2010 will be twice as joyous?

Click here to join in on the Fifty Family Focus for 2010.

Four More Children to Travel to Surgery

July 20, 2009 by Jessica · 282 Comments 

Tuesday afternoon PLC staff will travel with four children to the Anadolu Sağlık Merkezi in Istanbul, Turkey where they hope to receive life-saving heart surgery at the hands of Dr. Sertaç Çiçek. We are excited to introduce them to you one by one throughout the day today here on the PLC blog. We are in the final process of waiting for cooperative funding and passports before boarding the plane in a little over 24 hours.  More pictures and stories to come…

Heran & Shwan In Airport Headed Home After Life-Saving Surgery

June 2, 2009 by Jeremy · Leave a Comment 

Things happened so fast we never even introduced you to Shwan… but 10 year old Shwan also had life-saving heart surgery this week. Heran finished strong and left the hospital in a little flower hat… Thanks for all you’ve done!

Dr. Sertaç Çiçek & His Life-Saving Crew

June 1, 2009 by Jeremy · 5 Comments 

Has there ever been assembled a better group of surgeons to routinely tackle some of the most confounding heart conditions in the world? Iraqi children and all of us at the Preemptive Love Coalition are deeply grateful to this group of Turkish doctors who have given up so much this week to bring life today and peace for tomorrow.

Heran is Out of Surgery & Breathing On Her Own in ICU

May 29, 2009 by Jeremy · 638 Comments 

Heran’s surgery was not quite the masterpiece that the doctors were hoping for. Unfortunately by the time a child reaches 7 years old there are so many years of damage that have been done to the heart by overworking, high pressure, and lack of oxygen that some of the damage is irreversible.

In Heran’s case, her pulmonary pressure was too high to perform the Fontain procedure they had hoped to do. But they were very happy with the by-pass they performed and though her pressures are still higher than they’d like, they predict she will leave ICU tonight and return to Iraq in a few days.

We’ll probably talk about a second surgery for Heran in the next year or two to finish the Fontain procedure.

In any case, she is doing wonderfully! One of her doctors said she was “perfect!”

Photo: Matt Addington

Taban Recovering well

March 1, 2009 by Ruth · 3 Comments 

Taban is back in Kurdistan after having her life saving surgery in Turkey. She’s recovering well at a relatives home in the city where we live. She’s from  small village about a hour away so the doctor asked if she would stay here in the city for a few weeks so that we, along with the local peadiatric cardiologist can monitor her progress. Both Taban and her mom said that they had a wonderful time in Turkey, their experience was “perfect and could not have been better”.

Taban is 13 years old and has not been attending school for the past couple of years so we’re trying, along with our partner organisation here to encourage her to start going to school again.

We’re going again to visit her this afternoon in the home of her relatives. Here’s a picture of Taban recovering in hospital after her surgery.

Ahmad Out of Surgery! No More Blue Skin! All is Pink & Healthy!

February 17, 2009 by Jeremy · 1,031 Comments 

Ahmed is out of surgery. His oxygen levels are already up by 25%. His future is hopefully less blue and a more healthy pink. His dad is crying tears of joy.

Dr. Çiçek at the Anadolu Sağlik Merkezi was clear that this is not a long-term, fully corrective solution; but this first surgery should allow him to finally live long enough to receive the staged surgeries he’ll need over the coming years to actually live a fully functional adult life.

We’ll update with more information as soon as we know it.

Follow Ahmad’s daily updates on Twitter or via his RSS feed.

Taban Comes Through Her Surgery!

February 16, 2009 by Ruth · 2 Comments 

Yesterday at 0900 Taban underwent a 3 hour surgery to close the hole in her heart! Our staff in Turkey emailed last night to say that the surgery went well. We called her family to let them know and they sounded so excited! We’ll update you when we hear more!

You can follow Taban’s progress on Twitter or via RSS here.

From Airport to Hospital (Istanbul, Turkey)

February 15, 2009 by Jessica · Leave a Comment 

Right now we’re driving to the hospital from the airport in the ASM shuttle. After traveling all night these kids are definitely tired, but overall in good spirits. Taban showed up in pig tails at the Suli airport as we began our travels. Ranu came with her baby doll that she loves carrying around and picking up as though she is a real baby. Zana came entertained with an electronic handheld game. Ahmed is as sweet and shy as ever, slowly taking everything in around him. They all love the shiny star stickers. Zana is even wearing one on his first forehead.

Waiting in the lobby just before boarding Ahmed was fascinated by the airplane just outside of the windows. He took in every part with great awe. Once we landed in Istanbul, I wondered what Taban, coming from a small village, was thinking as we walked through the Istanbul airport. With great enthusiasm she looked from one conveyer belt to the next and then insisted on pushing a luggage cart, even in her tired state. I think it was as fun for her as any game could have been.

Five of the Great Eight Land in Turkey

February 15, 2009 by Jeremy · 49 Comments 

We’re happy to announce that five of the eight surgery candidates have successfully landed in Turkey, have been received by ASM – our medical partner in Turkey – and are beginning the necessary steps to undergo surgery in the coming days.

If all goes well, some of them will be back with new hearts in as few as two or three weeks.

The second group of the Great Eight is set to travel on Tuesday night!

Thanks for your support and generosity!

Preemptive Love Coalition

« Previous Page — Next Page »