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)

Backed Into a Corner: Doctors Adapting to Hardships in Iraq

June 30, 2010 by Preston · Leave a Comment 

As a doctor, decisions that affect a person’s quality of life come with the job, and this is no different for our local cardiologist, Dr. Aso Faeq. While shadowing Dr. Aso in his office earlier this week, I witnessed how the problems in Iraq make these decisions even more difficult.

As I saw patient after patient visit Dr. Aso’s office last Wednesday, the fact that congenital heart disease is a rampant problem here in northern Iraq became blatantly obvious. Families drove for hours just to see this one cardiologist examine their child, and so many of them were told about the urgency of their child’s heart condition.

Though so many cases are urgent, Dr. Aso is restricted from the limited options he has available to him in Iraq. The lack of training and technology for doctors along with poverty and cultural dilemmas prevent many children from receiving surgery in the country. It’s hardships like these that affect Dr. Aso’s decision making every day.

One of his decisions that resonated with me concerned the fate of a three-month-old boy. His parents brought him to the office knowing he had a heart problem, but they needed Dr. Aso to examine and diagnose him. After a few seconds of doing the echocardiogram (an ultrasound of the heart), Dr. Aso’s whole demeanor changed instantly.

He explained to us that two of the little boy’s heart chambers were malformed and merged into a single chamber causing immense pressure to build in his heart. As the family and Dr. Aso discussed their options, the limitations became obvious. The surgery the child needs could be done in a town six hours away, but the family did not have the money to do this. On top of this, the next group of American non-profit surgeons who will perform local surgeries here does not arrive for another fifty days, which could be too late for the dying boy.

For a solid 10 minutes Dr. Aso did not say a word. He sat there, weighing the child’s options and deciding his fate. Imagine the immensity of this decision. Dr. Aso has basically been backed into a corner and told to make a decision on this child’s life. And so, he did. Waiting is the only option. He spoke to the parents, comforted them, signed the papers, and watched as the next patient walked in.

Dr. Aso often finds himself faced with difficult decisions, but with the options available to him he takes the initiative to make the best call for these children. These families are, in fact, some of the strongest people I have ever witnessed. They face impending tragedy while dealing with poverty and neglect. Sitting in Dr. Aso’s office, however, allowed me to see that real initiative can cause real change in the face of immense hardship.

People like Dr. Aso take this initiative as far as they can, and PLC hopes to offer opportunities for this initiative to be extended across the world. Whether it be through buying Klash from our Buy Shoes. Save Lives. program, supporting local healthcare through Remedy Mission, or creatively partnering with PLC to find new ways of providing these heart surgeries, you can also take the initiative to make a difference in childrens’ lives.

Photo of the Day

June 16, 2010 by Lydia · Leave a Comment 

PLC interns have recently worked with local shoe makers to design the first-ever pair of female Klash! Here, a Klash-maker cuts ribbon for the bow, which is one feminine aspect of the new shoes. Pre-order a pair here for a limited time only.

www.buyshoessavelives.com

A PLC Intern’s Thoughts on Brain and Feet Soup and New Cultural Experiences

June 16, 2010 by Preston · Leave a Comment 

Experiencing Iraqi culture in a variety of ways is one of the great parts of being a PLC intern. The tasks we take on allow us to build meaningful relationships with new friends as we work. So far, a few of us interns have been a part of this relationship building through working with our new friend Aram. Aram is a local Klash maker who uses his unique gift to help PLC provide much-needed heart surgeries for children right here in his home country. For the last few weeks, the interns have been working with Aram on new ideas for Klash. Day after day, at least two of us have been frequenting his shop, speaking in broken language, trying to communicate new ideas, and in doing so, slowly building a great relationship while experiencing a new and exciting culture!

This culture is one of great hospitality. Every time we step foot in his shop, Aram is quick to offer water and tea. Often times we try to pay for the drinks he gives us, but the gesture is always denied. Many people here have a joy about them as they serve their guest. Even after three weeks of our visits, Aram never fails to extend his hospitality. On one of our latest visits, we partook in a rather unusual adventure of the culinary type.

While sitting in Aram’s shop during lunch time the other day, he asked if we would like some sêrûpê. This dish that I’ve only heard tale of, has often times made our Iraqi friends laugh by even just mentioning the name. The food that was brought to us was a green-yellow, brothy mixture containing sheep brain, foot, tongue, and mid-region. I know the thought is quiet unappetizing, but after timidly tasting the first bite, we understood that the Iraqi people know what’s going on when it comes to food. They can even make sheep brain and feet taste delicious. Served with a tortilla-type bread called naan, the meal could not have been more delicious.

Along with experiencing the culture through food, we’ve also experienced a type of relationship building that can only be formed by sitting in a Klash shop in the middle of Iraq while sipping hot tea. After sitting around a bit and talking about our new Klash ideas, the conversation can quickly drift to dugolie (the Kurdish word for “soccer” or “futbol”), especially focusing on the World Cup and the many reasons why Aram thinks Germany will win it all. We talk about the trade, argue about sports, and work on Klash together. Spending time in Aram’s shop has been one of the best ways of experiencing the culture so far.

Photo of the Day

June 7, 2010 by Lydia · Leave a Comment 

Klash are a Kurdish tradition in footwear. PLC works with local shoemakers, selling pairs of Klash to fund heart surgeries. Its a beautiful way to invest in the community on another level!

Photo of the Day

June 3, 2010 by Lydia · Leave a Comment 

Three members of PLC’s staff meet with KakAram to design a more modern, feminine pair of Klash. KakAram is a local shoemaker here in Kurdistan working with us to sell shoes and save lives!

www.buyshoessavelives.com

The Preemptive Love Coalition covered by NEED Magazine

February 16, 2009 by Jeremy · 60 Comments 

Thanks to Michael Duffield and NEED Magazine for covering Kadeeja’s stories and lending your voice in support of the effort to help Ahmad and the others from the Great Eight whose surgeries we are funding in Turkey right now.

Click here to read the article online.

PLC’s Buy Shoes. Save Lives. Klash in GOOD Magazine

January 26, 2009 by Jeremy · 830 Comments 

Thanks to all the kind folks at GOOD magazine for the generous inclusion of PLC’s one-of-a-kind life-saving KLASH – hand-made by the Kurds of Iraq.

[wpsc_category=10,full]

Introducing Kids Klash!

September 14, 2008 by Jeremy · 5 Comments 

In all of the recent excitement over the last couple of months about our internship program, expanding partnerships in the US, and, most of all, even more kids who are returning home with healed hearts, we’ve barely mentioned an exciting new product that will help the Preemptive Love Coalition fulfill its mission to fund heart surgeries for the no less than 3,000 children in Iraq who are dying on a waiting list.

Kids Klash are a great way to help younger kids connect with the lives of their global peers. Many of the kids on the surgery waiting list are between the ages of 1 and 6—the same age range that will be able to enjoy wearing Kids Klash. When a child has the chance to wear a great handmade shoe, it provides an opportunity to teach them about the wider world and the challenges of poverty and conflict faced by kids like them around the world. It’s not quite walking a kilometer in someone else’s shoes, but it’s at least a start.

Kids Klash don’t just help build perspective—they make a real difference, too. These shoes are handmade over the course of 20 hours per pair by village cooperatives, by prisoners seeking to rehabilitate their lives, and by victims of landmines seeking a living wage. Each purchase invests money in their economy. And, even more, each purchase helps to fund a heart surgery for one of the 3,000 Iraqi children waiting for the chance to live.

With a lower price (only $25!) and a more kid-friendly rubber sole (water and washing are no problem now), Kids Klash are a perfect way to change lives and save lives.

CLICK HERE TO BUY KIDS KLASH NOW!

Happy Birthday, BSSL! Meet PLC!

July 7, 2008 by Jeremy · 1 Comment 

On July 7th, 2007 an amazing thing happened… a guy named Chad was the first of hundreds and hundreds of compassionate people to purchase the as-yet-unknown shoe called Klash. Chad and hundreds like him have given us the encouragement and confidence we’ve needed to keep selling Klash and using the proceeds to fund heart surgeries for Iraqi kids.

And as cliche as this is about to sound, lots of people thought we were crazy. Most thought it was a three week project that we would outgrow. Some thought it was a silly failure to comprehend the real needs of Iraqis. Indeed, at times we probably thought so ourselves. But as one month has turned to twelve, there is no denying the magnetic force behind the simplicity of our message.

The Preemptive Love Coalition, via the “Buy Shoes. Save Lives.” program, has now sent 13 kids to surgery, funding them at various stages along the way to the tune of $36,500. What a pretty tune! We raised and gave away an additional $16,000 for pre-op heart screenings and have money waiting for 6-7 kids that we plan on sending later this month.In 12 months we’ve invested nearly $22,000 into local klash-making economies, plus tens of thousands more into the broader economy as a by-product of operating our business. We’ve sold $33,000 of Klash across the US, UK, Europe, Africa and Australia, and have seen such a range of creativity exercised in helping these children that we sometimes just sit astounded at all you do!

One of the major developments of the past year is the way in which we’ve reorganized under the banner of The Preemptive Love Coalition. After 4 months of selling shoes to save lives we started realizing that we had more to say than “buy shoes. save lives.” We wanted to say “Love your enemies. Do good to those who do bad to you.” In a region where “tit for tat” is the predominant peacemaking method, we wanted to lead out with another option.

Our “this for that” model is as simple as encouraging those who would be with us to find something in their current environment and use it (“this”) in the service of the thousands and thousands of Iraqi who are waiting in a line for life-saving heart surgeries outside the country (“that”).”This for that” is also about giving back love for hate; kindness for oppression; truth for perceptions.

As we look forward to the coming year we envision moving deeper into the hurt of Iraq and working among the more oppressed and excluded groups of people. We want them to know that there is an entire movement of people in America and around the world who will not abide the ongoing retaliatory methods of “peacemaking” in the region. We are those who use all manner of “this” for that – for peace; for kindness; for truth.

We are The Preemptive Love Coalition. Thanks for being with us!

Jeremy, Cody, Michelle, Ruth, Scott, Bobby
Audrey, Angel, Chris, Colby, Jesse, Peter (THE INTERNS)

Large Sizes Available (Limited Time)

June 8, 2008 by Jeremy · 4 Comments 

Just a quick note to say that we have a limited number of 11″ and 11.25″ Red/Blue and Blue/White shoes available for those of you who have been patiently waiting for some larger sizes to come along.

Due to our limited quantities, please email us at orders@buyshoessavelives.com and we’ll make sure we get you all the information you need to buy that pair of gargantuan shoes you’ve been waiting on.

Peace on earth,

Jeremy

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