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)

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

February 14, 2013 by matt · Leave a Comment 

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

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

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

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

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

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

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

    Houston Baptist University – February 19 – Houston

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

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

    Ecclesia Church – February 24 – Houston, Texas

    Eastgate Community Church – February 25 – Cincinnati, Ohio

    Cedarville University – February 27 – Cedarville, Ohio

Photo Credit: Calvin College

At Home With Hussain—A Followthrough Checkup

January 31, 2013 by matt · Leave a Comment 

People sometimes ask us, “So, what happens to these kids after surgery?”

It’s a great question, but it isn’t easily answered. Thanks to you and our partners, we’re now providing exponentially more surgeries than we did during our early years. What once was 20 children per year is now 20 children per mission—over 300 children this year alone!

With that kind of volume, it’s difficult to keep up with all the families we help. But we still work to follow up with as many as we can; to make sure they don’t slip through the cracks. But the nature of that Followthrough has changed. Now we spend time encouraging local doctors to follow up with families, reminding them to call families for post-operative check-ups.

And, due to safety concerns, it’s often easier for families to come see us at the hospital (the last thing we want is to disrespect our hosts!).

Going cowboy and riding a taxi into downtown Fallujah to visit a family is not a good way to maintain relationships with partners and friends of the program.

One misstep could lead to someone getting hurt, the program getting canceled, and children not getting their hearts fixed—not something we’re willing to risk.

So we’re tip-toeing into these home visits with care, and Hussain was our first. Stay tuned for (hopefully) many more to come!

Update From The O.R.—We’re Saying Goodbye To Zahraa!

October 10, 2012 by matt · Leave a Comment 

Zahraa has passed the test!

Her echo went well, and now she can go home. Watch the above video to get a quick update on Remedy Mission XII and to see shots of little Zahraa heading home with a healed heart!

Stay tuned for more stories from Remedy Mission XII—and we’ve got an update on Hussain coming as well!

Our Partners:

Update From The O.R.—Welcome to Remedy Mission XII!

October 4, 2012 by matt · Leave a Comment 

We’re back in Najaf for our 12th Remedy Mission!

If you’ve been following our work recently, you may be surprised to hear we even left the city since we just wrapped Remedy Mission XI there a couple weeks ago. Some of the local hospital staff weren’t even sure we’d left!

But the first patient for this mission was lifted onto the operating table this morning, and we’re excited to introduce her to you. She’s a little 6 year-old girl named Zahraa, and she’s getting her heart fixed now!

Watch the video above to hear more about her situation, and then come back in a few hours to find out how she’s doing.

More to come…

Our Partners:

VIDEO: Update From The Operating Room— “Thank You!”

September 26, 2012 by matt · Leave a Comment 

This is our final O.R. update for Remedy Mission XI in Najaf, and we can’t think of a better time to thank you for the lives you’ve helped save than right now! You made this a happy ending.

You gave money that bought plane tickets that led to training that saved lives and led to Iraqi doctors saying things like “I never imagined I would be learning to operate like this!”

So thank you!

Also, please allow us to use this space to thank our partners at Living Light International for their role in setting up this mission with the Ministry of Health and the provincial government of Najaf. We could not do this without their expertise and their devotion to the cause and their belief in the vision toward which we are moving. Also, we are grateful to the International Children’s Heart Foundation and their cadre of staff and volunteers from Memphis to Melbourne. None of the staff at PLC have any of the medical skills necessary to save these sweet children. Our hopes and our vision for the future of Iraq would be dead in the water without Dr. Novick and ICHF.

In the video, we also share a bit about Hussain and his progress as well as info on our fast-approaching Remedy Mission XII, where we’ll introduce you to even more amazing children in need of lifesaving heart surgery. You can donate below to partner with us further, and keep reading here on the blog—the best is yet to come.

Help us go back to Najaf to save more lives by donating below!

Our Partners:

A Word Of Thanks To Our Partners!

September 21, 2012 by matt · Leave a Comment 

Missions like this wouldn’t be possible without our excellent partners: Living Light International, The International Children’s Heart Foundation, and the local doctors and director of health in Najaf.

Thanks to them, 14 children received heart operations during Remedy Mission XI, and thousands of hours of hands-on training were provided to local professionals. Find out more about their work online here:

International Children’s Heart Foundation: Website | Twitter | Facebook

Living Light Internationall: Facebook | Twitter

And get ready for our next mission with these great people—Remedy Mission XII is coming soon!

VIDEO: Update From The O.R.—”I Finally Met Hussain!”

September 19, 2012 by matt · Leave a Comment 

We’re in Najaf for our eleventh surgical Remedy Mission, and Jeremy just met Hussain! If you’ve been following his story, you know that we’ve had ups and downs in our attempts to get him surgery. But he is finally getting it here. Watch the video to see footage from his first day at the hospital, and then follow this link to see his campaign page.

Stay tuned for surgery updates…

Our Partners:

Hussain Is Finally Here, And We Showed Him Pictures Of You!

September 17, 2012 by matt · Leave a Comment 

At long last, our spunky little star has arrived! In Hussain-like fashion, he immediately began giving out high-fives and challenging local staff to imaginary games that he somehow always won.

Most of the children scheduled for surgery just show up and get it a few days later, and that makes it tough to connect with the kids and their families.

But Hussain is different. I know him, the locals know him, and you know him. He’s a familiar face to all of us.

And that’s why we’re so excited to share his journey through the hospital with you! He’ll start with an echo (a screening) to check up on his heart, then he’ll wait while the doctors make sure he’s a good candidate for surgery. Then, if he’s chosen, he’ll be prepped and sent into surgery, then released into the ICU, and then—if all goes well—he’ll be sent up to the ward to rest and await his release.

We plan to take you along this journey, so keep reading over the next week to share in Hussain’s excitement as he gets his heart fixed!

Before all of that, though, I wanted to tell him about you, so I grabbed a computer and showed him his personal update page. Below are some of the photos we grabbed of him perusing the site. If you haven’t seen it or left him a message, it isn’t too late! Head over by clicking here and leave him a photo, video, or note wishing him a successful surgery.

Our Partners:

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:

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:

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