June 19, 2012 by Jeremy · Comments Off
The only bad failure
is the one from which we fail to learn.
Most organizations put a premium on celebrating successes at the end of every year—we certainly do!
But we also believe that we have a great deal to learn from our failures, so we endeavor to share them and the lessons we’ve learned in hopes of avoiding those same mistakes in the future.
When seeking to tackle intractable problems in an environment like Iraq, missed opportunities, missteps, false starts, and failures are par-for-the-course. There will be no improvement in the political situation in Iraq, in the economy, in healthcare, or in the pursuit of peace without a number of flops and failures along the journey. If we already knew what worked, we all would’ve implemented it by now and moved on.
The truth is, neither the American government nor the Iraqi—neither international nor local NGOs—truly know what works in Iraq. Most of us are making educated guesses and seeking to rightly adapt programs and principles that have proven successful at other times in Iraq or in other parts of the world.
From this point forward, I want to provide you with an annual (and sometimes real-time) assessment of our failures. In absence of such previous reports, I will use a few minutes to highlight our most meaningful setbacks, failures and lessons learned to date.
The three major failures of 2011, to be covered in this report are:
Failure #2: High-mortality Remedy Missions in February/March 2011 (Read about Failure #2 here)
Failure #3: The Loss of Our Sulaymaniyah, Iraq Surgery Site as a Major Developmental Partner; Lack of Surgical Capacity Increase As a Result of Remedy Missions Conducted
Let’s get started…
Failure #3: The Loss of Our Sulaymaniyah, Iraq Surgery Site as a Major Developmental Partner
Unfortunately, it became obvious in May 2011, after completing two Remedy Missions to the Sulaymaniyah Center for Heart Disease, that local organizations and hospital leadership were not committed to the partnership. In-fighting over child selection, credit sharing and cost sharing dogged the nascent partnership from day one.
We struggled for one year to make the partnership work. But ultimately, we failed to keep it all together. What we deemed to be petty lines in the sand gave us deep concerns over the ability of local players to see our program through to the 5-year completion that we had all discussed and envisioned.
Our March 2011 Remedy Mission IV was a huge disappointment in many ways. We went back to the drawing board and made a few required upgrades before our international team would agree to work again in the hospital.
By May 2011, as we tried to put the final touches on our next mission to the center, the local hospital had failed to made requisite upgrades in hardware, medications and supplies.
In consultation with our international partners, we ultimately issued a vote of “no confidence” and cancelled the pending mission.
In many ways this felt like a waste—a waste of nearly 8,000 of cumulative training hours; a waste of financial resources on a program that apparently lacked the willpower to see commitments through to the end, etc. All we had to show for our two missions in the city were 42 operations—including a few ground-breaking, inspirational cases; some amazing stories of peace and reconciliation; and eight deaths.
Within six months, we heard that the heart center was moving forward with an Italian team along a contract similar to the one we had originally proposed. The Italian mission in the Fall 2011 was deemed a success, and many surgeries were performed, but after the mission was completed rumors again circulated about local politics and an apparent inability to mobilize the center toward a long-term contract with the Italian team.
In a January 2012 meeting with the Director of Health for the province, we inquired about the number of surgeries that had been performed since our team and the Italian team had conducted three surgical missions to the city. To our great disappointment, the health director laughed and asked if we were joking, saying that the hospital’s surgical capacity had not improved in the previous year, in spite of the three missions. He laid the blame at the feet of local staff and the politics and health and not at the feet of the international teams that had attempted to help.
I’m not entirely sure we’ve learned all there is to learn from this yet. Our inability to woo or influence the hospital leadership into making the necessary upgrades was frustrating, but it is still unclear how we could have sweetened the deal or foreseen it coming prior to the May 2011 deadline that we set.
I am grateful that we made the decision to pull the plug on the program rather than continue to invest valuable resources (from all parties) into a stagnate program. The cumulative work done by international teams in the Center over the course of one year should have led to a measurable increase in surgical capacity. That is how our programs are designed and we are seeing an increase in capacity in other cities.
One question that we have contemplated is the idea of exclusivity in our contracts with a hospital. Should we insist on exclusive rights to train in a hospital, in an effort to increase commitment, decrease the opportunity for communication breakdowns and competing interests, etc? In the southern cities of Iraq where we work (where security risks are a much greater concern and where development is further behind the northern cities), we do not have competing interests. This appears to have created a greater loyalty and a healthier trust between our international and local teams than anything we were able to achieve in Sulaymaniyah. Our inclination continues to be against such exclusivity demands, but the question has come up as we seek to understand what went wrong and how we can avoid it in the future.
We cut our losses before running a mission in a dangerous environment. Perhaps most importantly, we cut our losses on a program that showed little organizational leadership and, in the words of the health director himself, zero increase in surgical output resulting from our educational, material, and infrastructural inputs. While the loss itself is a huge disappointment and I feel a personal sense of failure for my inability to cobble together a solution, it could have been so much worse.
It has been an exhilarating year in so many ways. But the above failures have been sobering. Yes, children are alive that may not be if we had not intervened. But it is undoubtedly true that children have died because we intervened. If our mandate is primum non nocere—first, do no harm—then it is cleared that we have failed on that front at least a few times this year. At least one was related to indecisiveness—a leadership failure on my part. Some of the other deaths were to be expected given the risks that were clearly communicated to the family. But we do not only seek to “do no harm.” We have another object in view: we seek to do good. And we did not attain the good that we desired in our now defunct partnership. For reasons to which we are not privy, they have failed to increase their surgical output as a result of our efforts. We made the right decision walking away from the partnership for the time being. We will remain open to reengaging in the future if local conditions change.
I am most impressed and proud of our team’s willingness to confront and respond to failure on a trip-by-trip basis. When it became obvious that a mission could not run without an international cardiologist, we responded. When the local conditions required staggering the deployment of extra nursing staff so that ICU care could extend in a professional manner beyond the duration of the official trip itself, we responded. And when we were urged to move ahead with a mission in spite of conditions that we believed to be unsafe, we responded by canceling the trip.
There are at least a few viable philosophies as to how one should develop a pediatric cardiac care program. Some progressive; some conservative. Some are boring and more predictable; others are inspiring and innovative. We are proud to work with professionals who employ different methodologies and adhere to different philosophies of development. We will no doubt continue to face difficult days as we face down death and attempt to eradicate the backlog of Iraqi children waiting in line for lifesaving heart surgery. But we envision a day in the future when every child across the country has access to the care they need within a 3 hour car ride. And we will continue to labor toward that end.
If you have any questions or concerns about this report, the decisions we’ve made, or the direction we are going, please email me at your convenience. I would love to hear from you.
July 24, 2011 by Ryan · Comments Off
1: Dressing up isn’t only about looking good
For the most part, in America, men don’t dress up to impress their platonic male friends in social settings. When going out somewhere, whether it’s a sporting event, coffee shop, fast food joint or just hanging out somewhere, men typically don’t dress to impress their male friends. We just don’t. If I showed up to have lunch with a friend wearing slacks, dress shoes and a button down shirt, he’d almost be sure to ask where I was coming from or where I was going, that required such attire.
Would you press your shirt and throw on a tie for an all-guys backyard barbecue? Would you shine your shoes and put on slacks to go watch a ball game at a friends house?
Let’s be honest. The answer is no, you wouldn’t.
But the Kurds do. Every weekend in the bazaar, at tea shops or just walking in the street I see Kurdish men wearing slacks, button-down shirts and the shiniest shoes I’ve ever seen in the dustiest place I’ve ever been. Here in Sulaymaniyah, dressing up is not all about looking good. It’s an expression of respect to the people around you as well as to the friend you are meeting for tea. Dressing up isn’t about demonstrating how dapper you can look. It’s about wordlessly saying, “The time I spend with you is a special occasion, and that is worth dressing up for.”
2: Hospitality isn’t just refilling the bowl of potato chips
I always try to be a good host when people come over. I’ve got the basics down – offer them food, offer them drinks, “is there anything I can get you?” – you know, the usual. But since coming to Kurdistan, I’m realizing that hospitality isn’t just refilling the bowl of potato chips; my hospitality should not be confined to guests at my house.
While being here, so many Kurds have gone to great lengths to show me hospitality: from physically leading me to my destination when I’m lost (despite it being in the opposite direction of their destination) to spending entire afternoons with me drinking tea, playing backgammon, teaching me Kurdish and talking about life. When was the last time you spent an afternoon with a stranger, let alone an acquaintence, just to show them a good time?
3: We all yearn for reconciliation
I entered Kurdistan harboring misunderstandings. Besides some brief reading of Kurdish’s history, most of my opinions of Kurdistan were shaped by mainstream media and ignorance. Let me tell you, that was a mistake. My Kurdish friends laughed as I explained the common perceptions of Iraq and Muslims in general, and grimaced soberly as they explained that Osama Bin Laden wasn’t a real Muslim because of the way he perverted, corrupted and twisted the teachings of Islam for violence and hatred.
My Kurdish friends laughed as I told them that not all Americans are like the people on Jersey Shore and that our nation isn’t entirely filled with debaucherous hedonists. They nodded disapprovingly as I spoke about the Westboro Baptist Church and their hateful and irreverent propaganda, and nodded in agreement as I said that we reject them as true representations of Christian theology and culture.
Many things became clear through these conversations, but the most profound epiphany I experienced was that we all yearn for reconciliation. We spoke about TV and culture, but what we were doing was reaching for common ground, understanding, and reconciliation. In discussing our differences and our misunderstandings, we found a common desire for peace between our cultures.
Kurdish men spend a lot of time drinking tea, playing games, and socializing at tea shops. A Kurdish tea shop is completely different from how I imagined a tea shop, since I only had Starbucks and Teavanna to compare it to.
Please allow me to describe my first experience at a legitimate Iraqi tea shop buried in the center of the bazaar.
A returning 2010 intern, Alex, likes to call this tea shop “the catacombs.” So when he proposed the idea of revisiting his favorite place in Sulaymaniyah, another PLC intern and I were excited to visit this mysterious, catacomb-like teashop.
Alex led us through the winding streets of the bustling bazaar, when out of nowhere he dove into the small entrance of “the catacombs.” We walked through the narrow seating area and tea stand and then the room opened up to a huge floor filled with a mess of tables crowded with men.
The sights and sounds of the catacomb tea shop were awesome! The noise of dominoes slamming against tabletops, dice rolling across wooden boards and men’s laughter and conversation filled the room. The walls were lined in dirty, beige brick. These brick walls held pictures of Iraqi politicians and famous figures that seemed to transcend their canvas and stare creepily at you no matter where you moved.
The tea shop is a place where they can invite total strangers or friends to play games and drink cha (the Kurdish word for tea). The workers went around delivering tea, handing out games or repositioning cheap plastic chairs and metal tables to accommodate more Kurds. Every so often the old owner of the shop would come by to sweep up the endless amounts of cigarette butts scattered across the floor.
We found a small spot near the AC, and immediately our white skin and American-ness attracted eyes of friendly patrons eager to practice their English and help us out in our attempts to play backgammon. Anytime I play backgammon, a Kurd either playing or just watching, would move my pieces for me if I wasn’t quick enough to move them myself.
That day I spent over three hours in the tea shop losing almost every game I played, drinking tea and laughing with new friends. In Iraq, it’s normal to sit down and help strangers or foreigners with anything, even something as simple or insignificant as a board game.
And this friendliness isn’t just occasional. It’s a quality they practice daily. The Iraqi people really understand the value and importance of relationships. The culture here is saturated with qualities of hospitality and friendliness to strangers and friends, and I’ve recognized this level of love and friendliness as something I hope to adapt in my own life.
There are people in my life whom I haven’t seen in months and probably won’t see but once a year. When we meet again, we’ll spend most of our time discussing what’s happened since the last time we talked, trading stories and catching up on all the details. But when it comes to this particular Kurdish girl, it’s all different.
As an intern last summer I connected deeply with 8-year-old Nivar. Her sweet personality won all of us over, and her striking eyes captivated many of you. Her case was urgent and her parents’ money tight, but after a few pictures and stories, the donations poured in. You made it possible for Nivar to get surgery in Turkey last July.
I went with her, and I spent most of my free time in her room playing hand-clap games and learning the Kurdish names for colors. Without any language we became fast friends. I was there during her operation, and the photo below is the last I saw of her before leaving Istanbul for America. I didn’t get a chance to say goodbye.
But this morning, after 10 months, I got to see Nivar again. I was both nervous and excited. I couldn’t remember any of my Kurdish colors, the names of animals, or the rhyme we’d used in our hand-clapping games. We were greeted at the door and ushered into the house by Nivar’s parents. Just then, Nivar came running in from a back room, healthier than I’ve ever seen her. She seemed shy at first, very quiet and polite. After a few minutes I went out to the car for something and Nivar followed me. She threw her arms around my neck and kissed my cheeks, then started laughing and speaking Kurdish.
Not understanding a word, I quickly grabbed what I needed and let her pull me by the hand back into the house where she led me past all of the grown ups and into her room. First thing? Hand clapping games. We played with her doll, a toy piano keyboard and a story book written in English.
When her dad came in to call us to lunch she spoke hurriedly to him in Kurdish. He laughed and pointed at Nivar, then at me, and said carefully, “I love you”. My heart smiled. I remembered in the hospital in Turkey when Nivar had sent the same message through her (non-English speaking) father to me the morning of her heart surgery.
After lunch Nivar brought out her parent’s point-and-shoot to take pictures of me, her favorite way to tease me for the millions of pictures I’ve taken of her. It was so great to watch this little girl run around the room laughing; its hard to believe its the very same girl who could hardly catch her breath the last time I saw her.
As we got ready to leave, Nivar smiled and said something shyly to one of the Kurdish-speaking PLC staff. “She wants you to be her sister,” they translated.
My friendship with Nivar ranks high on my list of PLC Summer 2010 memories. Watching her grow more and more sick as her surgery approached, then actually standing at the foot of her operating table while doctors worked to correct her heart condition created an unforgettable bond between me and this little girl. 10 months later, I’m ready to start another summer of memories with Nivar and others like her.
If you’d have been in Iraq this week, you would have been invited to this feast.
It was a feast celebrating another healthy heart from our most recent Remedy Mission in northern Iraq.
Parzheen and her family invited us to come for a medical checkup and to see the rest of the family, including Parzheen’s grandparents and to spend a day with them in their village. All of this was to thank YOU for saving the life of their daughter!
It was a perfect day. Together with Parzheen and her family we filled the village with laughter as we filled ourselves with the most delicious Kurdish food.
Everything around their home was in full bloom. The turkey’s were gobbling. The chickens were out searching for worms. The garden was beginning to show signs of life. Parzheen was outside playing and keeping up with all of her brothers and sisters, things she couldn’t do before her heart surgery.
It was all perfect and we left Parzheen with a check up that was just as perfect. She’s doing great!
Our Followthrough Program is gaining momentum as we continue to see children each week that were served during our last Remedy. Stay tuned to see more of the stories you’ve forever changed!
As a new member of the PLC team, there’s always something to learn. One of the first things on the to-learn list was how to answer the question, “What’s your job?” in Kurdish. I usually use the term ‘social worker’ to describe what I do, so I asked my language tutor how to say that in Kurdish and she explained that there isn’t a word for it because there isn’t really a job like that in our city.
Because women tend to stay home, the need for a family advocate/social worker to come to them is huge. Unfortunately the need isn’t widely seen, and in many homes even basic healthcare knowledge is lacking.
Last week I went with our family services director, Jessica Courtney, to visit Leah, one of the children who received surgery in March. Jessica was there in the ICU to help Leah’s mom understand the importance of a feeding tube and, for the second time, I got to see her comfort and inform this worried mother about medicines, dosages and how to help her child recover.
Hospital trips and caring for a sick child can be fearful times, and mothers need someone they can rely on. We hope to be that for them.
Leah’s mother wouldn’t have understood the urgency of a feeding tube or her baby’s need for consistent medication if Jessica hadn’t been there.
This is why we Followthrough.
April 13, 2011 by matt · Comments Off
December 22, 2010 by Cody · Comments Off
At the end of the first Remedy Mission in Southern Iraq we served 22 families, corrected 45 heart defects and gave a collective 7,000 hours of training to more than 50 local doctors and nurses!
Kids conquered heart disease together, families built new networks of friendships, doctors gained mentors, nurses gathered inspiration, and a foundation was laid for what might someday become a fully functional, locally-run pediatric cardiac surgery center.
Thanks to YOU, the momentum has continued from our first Remedy Mission in Sulaymaniyah last August to the latest mission in Nasiriyah. As we get ready for 2011, both Sulaymaniyah and Nasariyah are preparing for 8 more Remedy Missions this next year!
The growing coalition of partners that continue to bring Remedy include all of us at PLC, our freinds at the International Children’s Heart Foundation, Living Light International, Kurdistan Save the Children, both the Iraqi and Kurdish governments along with local governments and ministries of health, and you!
Without your support, there would be no remedies like what we’re witnessing.
With your support, this will only be the beginning!
With each story that’s told through these missions, a growing community is being drawn to the people of Iraq. As a community, we’re not only beginning to grow in our understanding and love but we’re tangibly waging peace in both our local communities and in communities throughout the Middle East.
It’s a pleasure to be standing alongside you. Let’s press on!
December 4, 2010 by Cody · Comments Off
It’s hard to believe that it’s been four months since our first Remedy Mission. When we landed in August we met 25 Kurdish and Arab children with severe heart defects. Over the past few weeks we’ve had the privilege to see those kids again, this time with WHOLE and HEALTHY hearts inside of them.
Remember Mohammad Fwad?
He was our last child to be taken out of ICU from the first Remedy. Not too long ago we stood alongside his mother and father, watching Mohammad recover so much slower than any of us were wanting. Recently we were able to stand alongside his mother again, this time being entertained by Mohammad and his new bike circling around the living room! He couldn’t be doing any better! To the side of the room was his three month old baby brother who was born the day Mohammad received his life-saving heart surgery.
It’s late for a Thanksgiving post – we know. But how can we not still be so overjoyed and THANKFUL for these healthy boys!
While we so often celebrate the moment a child enters the operating room and the moment that same child has fully recovered with a healthy heart, there are so many things that need to happen before that child even has a chance to be operated on. This is why we’re thankful for our staff here. They serve as each family’s personal advocate to fight for their child every step of the way. They help provide life-saving heart surgeries to one family at a time. Once we provide a family that, we follow up with each child until they’re fully recovered.
Four weeks ago, my wife and I moved back to Iraq, which is where we met in 2007. Since we’ve been back we’ve had the joy to accompany our local staff to the homes and families of each child that’s been helped these past few months. They know each address by heart and the parents love our staff like we are their own. We can’t blame them. We’re so incredibly thankful we have these friends.
We’re thankful for kids like Mohammad. We’re thankful for our local family advocates and all of our global advocates like YOU. You make this possible!
August 31, 2010 by Jeremy · Comments Off
Amed Omar has volunteered for us for more than two years. Amed invested heavily each day into the kids, showed an eagerness to use his knowledge of English and local languages to help in the training of local nurses in the Intensive Care Unit. | Photos by Heber Vega
As our first Remedy Mission has played out in Iraq over the last two weeks, we have been extremely encouraged by the number of people coming out, emailing, and calling in hopes of giving what they can as volunteers to assist in the effort. For years, a lack of voluntarism and a sense of entitlement among many throughout Iraq has caused us great concern for the future of crowd-sourced charitable organizations like ours. In Iraq many sit back and wait for the government to do it all. Too few go the extra mile of engaging the process, flexing their creativity, and creating the change that they ostensibly want to see.
But that is decidedly not how it was this week with Remedy Mission. We had 17 volunteers come out at some time or another to see the children, play with them, donate time, goods, and money, translate, function in administrative roles, write, advocate, promote, and – perhaps most importantly – become personally invested in the long-term drama of creating a long-term local solution for children in Iraq waiting in line for lifesaving heart surgery. In addition to the 17 who actually came and volunteered, we had another six on a waiting list that we simply could not absorb. We had to turn local Arab and Kurdish volunteers away!
Shahad Mohammad was a first-time volunteer with us this Remedy Mission after making friends with some of our summer interns. Shahad persisted in seeking volunteer opportunities, played with the kids, translated into Arabic, and involved others in her community in our work.
As we look to the future of charitable and social services in Iraq, we are encouraged by the diversity of youth and adults, ethnicities, and socio-economic backgrounds that comprised our volunteer group these last two weeks for our Remedy Mission. If we can continue to generate this degree of local support and leverage the good intentions and much-needed hands and feet of the people of Iraq, the kids of Iraq (where we live at least) are going to be fine under the care of their local volunteers, government and healthcare professionals.
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.