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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]

In a Word: "Aspiration"

June 15, 2011 by Lydia · Comments Off

Don't Move, an Iraqi student in a Wshyary village school Successful Weight Loss School

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Iraqi Kurdistan 2010. A classroom in Wshyary village school. Photo courtesy of Julie Adnan.

Filed Under: In a Word, Photography, School Tagged: chalkboard, Julie Adnan, Kurdistan, School, Wordless Wednesday, Wshyary

See One. Do One. Teach One. Remedy Mission Trains Iraqi Heart Doctors and Nurses for the Future of the Children and their Country

February 23, 2011 by Jeremy · Comments Off

Push play above for a peek into what it means for our volunteers to be here training local Iraqi heart doctors and nurses.

After you’ve viewed it, please “SHARE” below with Facebook, Twitter, StumbleUpon, Digg, etc.

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.

Our Partners

International Children's Heart Foundation Living Light International

Filed Under: Development, Featured, Featured Partners, Go Blog It!, Heart Surgery, International Children's Heart Foundation, Interviews, Living Light International, Local Doctors, Monthly Lifesavers, Nahoko Takato, News, Our Kids, Partnerships, Peacemaking, Photography, Remedy Mission, Surgery Updates, Urgent, Volunteers Tagged: Arab, Baghdad, Basra, books, cardiac, cardio, center, child, congenital, defect, Development, disease, doctor, dohuk, educate, erbil, heart, institute, International Children's Heart Foundation, Iraq, islam, Jeremy Courtney, kid, learn, living light international, muslim, najaf, nasiriyah, nurse, peace, perfusion, Remedy Mission III, School, shi'i, shia, shiite, sulaymaniyah, sunni, surgeon, Surgery, surgical, teach, thi-qar, train, volunteer, war

Just “A Little Longer” For Anwar

December 9, 2010 by Cody · Comments Off

This is Anwar. He’s homeless. He was also born with a congenital heart defect.

If you spend any time with Anwar and his mother, you quickly learn that they wouldn’t want any of those things to define them. Anwar would rather be known for his love for soccer. He’s in 1st grade but he can’t stand school, mainly because it takes him away from his father.

His father is a skilled farmer. They used to live down by the Kuwait-Iraq border and work on a farm where Anwar loved nothing else but to spend the whole day working alongside his dad.

Then the land ran out of water and they were forced to move further north.

When Anwar was one month old they found out about his heart defect. They traveled to Basra to see local doctors but they told them that they didn’t have the equipment they needed to save Anwar’s life. Even if they were able to buy the equipment, they still needed to be trained on how to use it. Regardless, they told them to just “wait a little longer”.

They went back every month to see if the machines arrived but for 6 years they were continually turned away.

Anwar’s only choice was to go overseas to a country that had the right machines and the doctors who knew how to use them. But it was a choice his family couldn’t even consider because of the cost.

Whatever savings they had was continually being put towards staying warm in the winter. If Anwar gets cold, his body begins to shake and his heart condition worsens. Because of that, all their money goes towards buying kerosene to keep the heaters burning.

This winter that kerosene bill may just be a little less because Anwar heads into surgery within the next hour! The doctors have the machines they’ve been waiting for and now they’re receiving the training they need to use the machines for the very first time!

Now, Anwar truly only has to wait “a little longer.”

Stay tuned…

Our Partners:
Living Light International International Children's Heart Foundation

Filed Under: Amazed, Go Blog It!, Heart Surgery, International Children's Heart Foundation, Living Light International, Local Doctors, News, Our Kids, Partnerships, Remedy Mission Tagged: Anwar, Basra, CHD, doctors, equipment, farm, homeless, International Children's Heart Foundation, Iraq, kerosene, living light international, Remedy Mission II, School, soccer, water

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

August 24, 2010 by Cody · Comments Off

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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,

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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.

Our Partners:
Living Light International International Children's Heart Foundation

Filed Under: Ahmed Talib, Amazed, Development, Go Blog It!, Heart Surgery, International Children's Heart Foundation, International Guild of Visual Peacemakers, Local Doctors, News, Our Kids, Partnerships, Peacemaking, Remedy Mission, Sulaymaniyah, Surgery Updates Tagged: Ahmed, healthy heart, Heart Surgery, Iraq, Lifesaving, pediatric heart surgery, Remedy Mission, Remedy Mission I, School, soccer

Sara is Doing Great Back in Iraq One Month After Surgery

April 25, 2010 by Jessica · Comments Off

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Sara and her father came by our office on their way to a check-up with the local cardiologist, Dr. Aso Faeq.

It was a joy to see her and talk with her. She is doing great and is enjoying a little time off from school. We talked about picnics and the results of recent elections. They told us in detail of their visits to Deelan’s family, who also went to surgery in March. They amazed me with their love for this little boy they didn’t even know until they met at the airport on their way to Istanbul. It is great to see healed hearts, bright futures, and relationships formed (and/or sustained) across some recent – and some more historic – barriers between Turkmen, Kurd and Arab in the city of Kirkuk.

We ended our time with them celebrating with the fresh baklava and chocolates they brought to say “thank you.” Thanks to all of you Woodway college students Sara is alive and thriving with her newly healed heart.

Follow Sara on Twitter: @SaraMuaeed. Subscribe to Sara’s updates via RSS HERE. Follow Sara’s thread of longer stories (with pictures & video) on the PLC blog HERE.

ADOPT A CHILD

Churches, universities, and other organized groups were the backbone of our large fundraising efforts in 2009—and now we’re looking for at least 12 churches, mosques, synagogues, universities, youth groups, etc to adopt an single Iraqi child to raise life-saving awareness and funds on his/her behalf. Group goals usually range between $5,000–10,000—though we’ve seen junior high groups raise over $8k and college students pull together $30k!

Email cody@preemptivelove.org or call us at (805) 245-4870 to discuss your group adopting a child for surgery.

Filed Under: Amazed, Featured, Financial Transparency, Go Blog It!, Heart Surgery, News, Our Kids, Peacemaking, Sara Muaeed, School, Surgery Updates, Valve, Volunteers Tagged: Arab, college group, Deelan Kameran, Dr. Aso Faeq, followthrough, fundraising, Iraq, kirkuk, Kurd, Partnerships, sara muaeed, School, turkmen

Shwana Gains Weight; Prepares for School Midterms 7 Months Post-Op

December 20, 2009 by Jessica · 283 Comments

We visited Shwana in his village today, arriving only two hours before his mid-term test. He sat politely with us talking about football and playstation then excused himself to go study for his test. Sitting under the kitchen window for light (because his house doesn’t have electricity during the day) he and his brother studied together.

We sat in the other room talking over their chants of memorization in the background. His mother proudly explained how he has now outgrown all of his clothes that were falling off his body before his surgery just 7 months ago. Weight gain can be a great sign of health in a post-op child!

His father arrived from his job as a teacher just before lunch in time to quiz Shwana a little before he needed to leave. The entire family exuded happiness and pride in him as we ate a delicious Kurdish meal. After a very quick lunch, Shwana left and hurried to school so he wouldn’t be late for his test.

It was a great day with his family and we are excited with him that what you made happen with a single surgery in Istanbul, Turkey has led to a completely normal life for Shwana back in Iraq.

Filed Under: ASD, Our Kids, School, Shwan, Surgery Updates Tagged: family advocacy, poverty, School, Shwan, village, weight gain

Bruska Ready for School in the Fall After Successful Heart Surgery Last January

June 27, 2009 by Ruth · 159 Comments

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Yesterday, PLC Family Advocates and Summer Interns went to visit Bruska. Bruska was all smiles while we were there. She really wants to go to school next year with her older sister. You can tell she really loves her family and that she enjoys being around people. As our physical therapist, Ruth, worked a little with her, her face lit up – especially while playing with her doll.

She is doing well since her heart surgery in January.

Filed Under: Bruska, Internship, Surgery Updates Tagged: bruska, Internship, School