May 22, 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 series of reports are:
Failure #2: High-mortality Remedy Missions in February/March 2011
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…
2011 Failure #2: High-mortality Remedy Missions in February/March 2011
In February and March we ran two back-to-back Remedy Missions. One was our second in the southern city of Nasiriyah; the other was our second in the northern city of Sulaymaniyah.
Over the course of four weeks of surgery, mortality rates between the two cities reached 20.5% (7 deaths out of 34 operations).
A few of the losses were very surprising to many on the local and international team and had an extremely demoralizing effect on the team (particularly in Sulaymaniyah). The loss of momentum undoubtedly had a qualitative impact on the care provided as the trip progressed.
Some of the factors were anomalous, such as our lead surgeon contracting an infection in a wound on his ankle that resulted in impromptu surgery inside Iraq to save his leg. But other factors were almost certainly preventable, beginning with case selection and moving to fundamental deficiencies in the hospital equipment and protocols themselves.
A lack of warming blankets, portable oxygen units, a ready blood bank and several other fundamentals led to a less-than-ideal environment for the teaching of pediatric cardiac care. As a result of all these factors and the inherent difficulties of open-heart surgery, mortality rates in the Sulaymaniyah mission reached 22% (four deaths)—unacceptably high by any standard.
None of the deaths were considered “surgical” deaths, in the sense that the child did not die on the operating table, but rather in the post-operative intensive care unit, ward, or—in one case—in the car on the way home after being prematurely discharged by a local nurse the day the international team left the country.
Our international team was very impressed with the local cardiologist for Remedy Mission II in the southern city of Nasiriyah. When it came time to schedule Remedy Mission III in that city, the decision was apparently made to not send a cardiologist on the mission, believing that the local team could handle it. This may have contributed to the imbalanced case selection in RM III and may have led to the situation in which three children died during the course of the mission.
Since that mission, an international cardiologist has been present on every Remedy Mission in an effort to help with case selection and create a balanced schedule of surgeries.
In Sulaymaniyah for Remedy Mission IV, case selection was complicated by the number of stakeholders in the mission. Children were formally and informally (that is, “politically”) put into the mission by the Preemptive Love Coalition, local cardiologists and surgeons, Kurdistan Save the Children (a local NGO), and the Health Directorate.
With regard to Yahya’s case, as described before, I can certainly say that my judgement was impaired when it came to case selection. I can speculate that other entities, in an effort to do right by the friends and patients on their lists, made similar errors in judgement that ultimately skewed the balance of the surgery schedule and its complexities.
When two children died in Sulaymaniyah after the international team left for the airport, we realized for the first time how ill-equipped the local team was to handle relatively simple post-operative care (one child had a positive prognosis in the ICU and the other was already out of ICU and recovering in the ward).
In our post-mission Impact Evaluation Report, we published the following statement:
Our post-mission conferences and deliberations on the matter resulted in the following protocols:
1. A mandatory reduction in “RACHS-1 scores” presented to the international team by the local team
2. A mandatory international ICU team to be left behind after surgeries stop to stave off post-mission ICU deaths and errant discharges
3. A postponing of our next planned mission to the Sulaymaniyah Center for Heart Disease due to lack of preparation of materials, equipment, staff, and protocols
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.
HE Vice President Abdul Mahdi recently held a press conference to share about the work of our coalition in southern Iraq!
From one section of the article:
“The initiative has the full support of VP Mahdi ‘because of the exceptional circumstances during the recent decades, the country is in an urgent need to establish centers that offer advanced medical services for cases of incurable diseases. Procedures such as heart surgery for adults and children, and that Iraq is now suffering from a severe shortage in this area of medical expertise.
Whether in the number of medical centers or experienced medical staff in terms of which Iraq has only 22 doctors specialized in heart surgery, while it does not have surgeons specialized in children’s heart surgery.’”
He also said that this team has done a great humanitarian deed, and noted that the country suffers from a dilemma which is the birth of approximately eleven thousand new cases of children with heart disease and this calls for concerted efforts.
To read more from this article on our groundbreaking surgical mission, visit here.
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 21, 2010 by Cody · Comments Off
It’s incredible to watch the journeys of these children and their families.
Most of the families come in individually carrying their children. The children usually stay in their beds with their mothers until they go in for their surgery.
Then the mother’s begin to grow closer as they wait for their children to come through the surgery and out of the ICU. When each child comes out, they celebrate and soon they’ll start walking their children or each other’s children down the hallway tightly gripping their hands.
Then one by one, each child gets stronger and soon the mothers stay in the room chatting while their children are running around on their own!
It’s a beautiful thing to be writing this post and be interrupted by the children we’ve grown to love so much.
Anwar and Fatima seem to grow stronger each day here in the hospital.
Today, Anwar and I colored. He drew pictures of palm trees and birds. I think we’re all counting down the days until we can leave the hospital!
December 19, 2010 by Cody · Comments Off
This week, little five year old Shams Hadi died during her 12 hour operation. Shams was born with a combination of three congenital heart defects. By themselves, those three defects aren’t unusual among children here but none of the doctors or cardiologists had ever seen the combination of all three in one child.
In a developed country, Shams should have received surgery at three months. Her five year wait had simply done too much damage to her heart and lungs and by the time she saw the doctors that could cure her, it was too late.
The doctors were astonished she had lived this long.
But this week there was one last chance to fight for her life.
Before Remedy began, I thought about what I would write in this post. I came into these two weeks knowing that lives would be saved but also facing the sober reality that it might already be too late for some of the children we’ve met.
Even though these surgeries are just in time for some and too late for others, every one of these children is having their story rewritten.
Their stories all began with them being born in a country that didn’t have the doctors or hospitals that could save them from their disease. While there were remedies, they are all overseas and out of reach for all of them. Before now, these stories were ending with them still dying without any options.
Now, stories are being rewritten so that children in the north and in the south are beginning to see the remedy for the first time.
For many, it came just in time. For a few, their story ends with them not alone but instead surrounded by an entire team of doctors and nurses who gave it everything they had to save their life.
Shams’ story ended that way. It ended with her family being surrounded by a community who had grown to love them deeply.
Bringing remedy to Iraq doesn’t mean we make heart disease a thing of the past. It means that every child born with heart disease has access to the care that they need to fight it.
And that’s why, during days like today, we don’t lose hope. That’s why we honor Shams and her family by not giving up the hope that soon no Iraqi children will have to wait as long as she did to be treated.
Thanks for standing alongside us, in the joy and in the pain.
Thank you for continuing to rewrite the stories of children and families all across Iraq.
December 17, 2010 by Cody · Comments Off
Ritha had one assignment before he could go home. Blow up a latex glove, something that he could never have done before his surgery.
He kept blowing until the nurses had to stop him because it was about to POP!
With flying colors, Ritha passed his test and was sent home with his father!
More latex gloves are being passed out and one by one, kids are getting to go home!
The ICU nurses hated letting Hassan go but there was no more reason to keep him from moving to the ward with his mother. Today, Hassan was freed of monitors and tubes and carried out to be with his family!
Beds are losing their patients and families are winning back their children as this Remedy Mission nears its end!
December 16, 2010 by Cody · Comments Off
Zahran decided she didn’t want to waste any time in the ICU after surgery!
A life-saving shunt was placed near her heart to increase the blood flow to her lungs. Before the surgery, she would struggle to breathe and the only thing her mother could do was to lift her legs up to ease the tension on her heart.
Today, her mother was able to carry her around the ICU before she was taken to the hospital ward to be with Fatima, Ritha, and Anwar!’
December 15, 2010 by Cody · Comments Off
Remember Ahmed, Noor, Hussein, and Riza from our first Remedy?
They remember you!
They were the group of four who traveled 600 kilometers north to receive their life-saving surgeries last August. Today, they only had to go down the road to show us how well they were all doing!
I didn’t even recognize any of them! Can you? Together, all four have gained a total of 33 pounds since their operation! All their parents said the same thing, “They won’t stop moving or eating!”
All signs that their body is getting stronger each day with their whole hearts.
Ahmed’s parents are doing great after their car accident. His father is back at work and his mom has the new full-time job of keeping up with Ahmed!
Riza’s mother said, “She’s a completely new child since the surgery. Before, she couldn’t stand or crawl but now she’s running everywhere!”
Hussein’s mother said, “He has a fresh face now! Before, he was tired and his heart would beat fast. Now he’s full of energy and his heart doesn’t hold him back.”
They thanked GOD for you today and they remembered how you made Remedy possible. They told me, “We’ll never forget what you did for us!”
December 14, 2010 by Cody · Comments Off
“I can’t even imagine what it would be like to live in a country with good healthcare.”
Those were the words of a mother of two. Both were born with holes in their hearts. Her youngest, pictured above, is Zahran.
Zahran was diagnosed with heart disease when she was seven months old. A bleak diagnosis is all the doctor could offer them. That and the hope of treatment overseas.
Zahran’s mother kept repeating, “We could not find a remedy here in Iraq.”
What would be harder to hear as a parent? The fact that your child has an incurable disease or that there is a cure but it’s just out of your reach?
When there is a remedy and when it’s within reach of some and out of reach for others, just based on where they’re born, then it becomes an issue of justice, doesn’t it?
Like all issues of injustice, it requires people to come running and take action.
It requires people to do justice.
Today marks the 6th day of operations and Zahran’s set to be the 16th child to be given what could be a life-saving surgery!
Because of YOU, Zahran’s mother can start to imagine what it’s going to be like to live in a country where the healthcare is strong enough to save her children.
What better gift could you give this Christmas than justice?
December 13, 2010 by Cody · Comments Off
Hassan’s surgery was a success!
When the doctors first looked at Hassan’s heart, he had multiple defects. When they were done with the operation, they had corrected each one of those defects and could only describe his heart as whole and complete!
Now Hassan is resting in the ICU, next to Ahmed, where the nurses continue to monitor how the rest of his body responds to his new and fully functioning heart.
Hassan’s wait for his surgery is finally over. Now all we’re waiting for is his return to his family.