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)

You’ve Forever Impacted 16 Children This Remedy…And We Still Have Two More Days To Go!

February 22, 2011 by Cody · 1 Comment 

16 Children

That’s how many children you’ve impacted this Remedy!

Thanks to YOU, Kautha’s recovering from her successful heart surgery. Her heart defect is a thing of the past. She’s passed through the ICU. Now she’s one hour closer to going home.

16 Families

That’s how many families you’ve forever changed!

Kautha’s family has been able to rest and be at peace for the first time since before they were told Kautha had a serious congenital heart defect. She called you the “mercy of God”, because of what you did for them.

16 Stories

That’s how many stories you’ve rewritten!

Now Kautha’s mother can smile and laugh when she talks about her hopes and dreams for Kautha. Her only hope until now has been for her daughter’s heart to be whole. Now that it’s whole…her hopes and dreams have returned.

The best part is that there’s still TWO more days of Remedy left in southern Iraq!

You’ve brought us this far, now help us finish strong by spreading the love by clicking the “share” button below to post this on your Facebook Profile and Twitter account!

You’re a part of the Coalition, now invite others to join you and save lives and wage peace in Iraq!

We love doing this with you!

If you’re on Twitter this week be sure to use the #RemedyMission hashtag to describe all the good news coming out of Iraq this week via @preemptivelove.

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Abdulkareem Gets His Surgery After Months of Appeals from His Loving Father

August 26, 2010 by Jeremy · Comments Off 

Photos by Heber Vega; Lydia Bullock

It was around lunch time in the heat of June in Iraq when Abdulkareem’s father came into my office. He told me that his son was very sick, that he was very poor, and that he needed our help and was willing to do whatever he could to make it happen. We were preparing our July group for surgery in Turkey and one of the children had just withdrawn from the group. It looked like we might be able to squeeze Abdulkareem in at the last minute if all the right pieces fell into place quickly.

Abdulkareem’s father worked especially hard for his little boy. He traveled from his home in Diyala to Baghdad to get passports for the family. He came to the office and called regularly to see what our status was with regards to funding for his son’s place on the Turkey surgery list.

There are two days in the duration of my journey with this family that I am unlikely to forget. The first was the day that Abdulkareem’s father – Hafez Bey – looked into my eyes and, with all the passion of a protective but powerless father, said, “Just help my little boy; just do something to save my little boy.“

Unfortunately, it did not work out to take Abdulkareem to Turkey with us for various reasons and we began the race against the clock to provide Abdulkareem surgery before his condition deteriorated any further. Our as-of-yet untested next option was our first Remedy Mission in August 2010. We gave Abdulkareem a priority spot on the Remedy Mission list.

The day our surgical team arrived Hafez Bey must have seen us on the news because he called me 10 times: “Is my boy going to surgery? Mr Jeremy, just do something to help my little boy!”

Photo by Heber Vega

There is one other day in the life of this family that I won’t forget – the day Abdulkareem had surgery earlier this week. I remember it so distinctly because after the surgery Hafez Bey grabbed me and kissed me and gave me an emotional “thank you” for making good on our commitment to his family.

One of the things we always try to explain to families is the presence of hundreds of people in the States and Europe – people like you – who work together to make every surgery possible. Of course, parents appreciate the ability to personalize their gratitude, but we talk about you frequently because we could not have saved Abdulkareem’s life without your many gifts to our Remedy Mission.

If you like what you’ve been able to be a part of this week with us (and there seem to be hundreds of you viewing the website and videos each day), please take two minutes to give toward the next Remedy Mission, the next Abdulkareem, and to the next father who is eagerly waiting for someone to help his little child. Please donate any amount of your choice below.

WIth You,

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

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Ahmed is Doing Great, Out of ICU and One Day Closer To Seeing His Parents

August 24, 2010 by Cody · Comments Off 

Ahmed is now one day closer to seeing his parents. His days of fighting against a completely broken heart are over! What’s ahead of him? Everything! His family, his home, his friends, his school, soccer and anything else any normal four year old with a strong heart would look forward to.

Today, I’m pretty sure I caught Ahmed daydreaming about all of those things as he just spent time relaxing before heading home sometime this week.

I remember meeting Ahmed just last week, with his knees to his chest because that was the only position in which he could breath properly. Now he’s sprawled out on his bed with candy wrappers all around him.

We are looking forward to our last few days with Ahmed and his uncle. Will we miss them? Of course! But we can’t wait for his parents to see him with a healthy, happy heart thanks to you!

With you,

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

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This is How We Wage Peace

August 17, 2010 by Cody · 1 Comment 

Photo by Jon Vidar

It’s cities like Baghdad, Fallujah and Nasiriyah that always bring to mind the hellish video clips and photos we’ve all seen flashed across our TV screens. Car Bombs. Kidnappings. Militias. Chaos. It’s true, the South of Iraq has dangerous places. What we don’t see flashed across our TV screens are the images of a different kind of war. A war we were all made for. A war for peace, wholeness, and reconciliation between enemies.

Today, in Southern Iraq, a car bomb killed 48 people. At that same time, a few hours away, a little boy named Hussein Ahmed, an Arab from the South, was receiving a lifesaving heart surgery from American & Kurdish doctors in the North because of people all over the world who fought to make it a reality for him and so many others. Hussein was the first of four children from Nasiriyah whom the Vice President of Iraq himself requested we admit to surgery.

Photo by Jon Vidar

At 6′ 5″, Dr. Novick towers over almost everyone. Doctors in Iraq have to get creative to observe and participate in surgery and training.

As we sat and talked with Hussein, his family, and the director of the hospital in Nasariya who traveled up to witness the surgeries, we spoke of cooperation, peace, and our desire to invest in families like Hussein’s and the countless others in his city that have been affected by war. One of the first questions they asked of us is, “Will you come to Nasiriya?”

This past week Dr. Novick, our first Remedy Mission heart surgeon, was in Nasiriya and families were literally running to bring him their children with heart defects. If they’re running to others for help, then we should run to them to give it.

It’s true, Nasiriya has often been a city that has seemed to be unraveling at the seams.  Will we go there? Are they worth the risk?

We believe they are. If it’s a place that’s unraveling, then it’s a place that we want to rush to mend. This week you’ve helped us wage peace and saved the life of the first of many of Nasiriya’s children. You’ve shown them that even when car bombs and explosions escalate, so too can love. You’ve reminded them that there are still people out there that believe in them and believe there can be hope in Southern Iraq.

You’ve shown Hussein that his heart is worth fighting for and now he’s continuing that fight in the ICU.

Help us tell the story of Hussein and the children from Nasiriya this week as we follow them to recovery!

With you,

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

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