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)

After Only 26 Hours, Ali Is Out Of The ICU!

January 20, 2012 by Cody · Comments Off 

Does this look like a boy who just had an open heart surgery 26 hours ago? I didn’t think so!

I got a phone call from Ali early this morning telling me not to bother looking for him in the ICU anymore. I walked into the hospital to find him walking around in the ward!

Not only that, but he was already asking me when he can go home. Ali still really wants to be a doctor, so maybe one day he’ll understand how important this time is in the hospital.

But I love that he’s still a 12 year-old boy who can’t wait to go home and play soccer with his friends. At this rate, who knows, he could even be home by tomorrow!

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Why Father's Day Means So Much to Hafez And His Son

June 15, 2011 by Jeremy · Comments Off 

At exactly this time last year, Hafez (pictured above) was facing down the worst Father’s Day of his life as he desperately worked against the clock to save his son’s life.

At exactly this time last year, we asked for your help… and you came through in a huge way, raising more than $30,000 in just a few weeks so we could launch our first-of-its-kind Remedy Mission inside Iraq.

At exactly this time last year, you made this father’s day and helped secure for him a happier life than the one he was facing without you.

Meet Abdul Kareem – the son of my friend, Hafez. When I met them, they did not have the money to pursue surgery outside of Iraq like all the rich people, people with political clout, or the lottery winners.

I’ll never forget Hafez’s plea to me – certainly the same plea I would make on behalf of my son – “Just do something for him. He’s just a little boy.” He got so emotional that he excused himself from my office. This father, having done all he could for his son, walked away from the office crying. Abdul Kareem needed heart surgery before his first birthday or he was likely to become entirely inoperable – “a lost cause.”

But you weren’t about to let that happen!

The day our surgical team arrived from all over the world for Remedy Mission I, Hafez must have seen us on the news because he called me ten times: “Is my boy going to surgery? Mr. Jeremy, just do something to help my little boy!”

His boy was going to surgery, thanks to those of you who gave in response to our request last year’s for Father’s Day and our Remedy Mission launch!

There is another moment with my friend Hafez that I won’t forget – the day his son Abdul Kareem had surgery. I remember it so distinctly because after the surgery Hafez grabbed me, kissed me, and gave me an

tearful “thank you” for keeping our word; for saving his son’s life.

Once Abdul Kareem was discharged to return home, Hafez sent me a message from the road. The message said something like, “Thank you so much for your organization and for helping my little boy. We will not forget you.“ With tears running down his face, he wanted to thank you each by name. You made a father’s dream come true. And you prevented his big brother, Abbas, from growing up without a soccer-buddy.

Dad, I love all the great memories we’ve made together. This year, I wanted to add, “saving a child’s life in Iraq” to the list, so that another child and his father can make great memories together too.

We want to make it easy for you to honor your dad this Father's Day and help save the life of baby Ghazel. A simple $10 donation will help us save her life and cover the cost of two hours of hands-on training with local Iraqi surgeons! A $25 donation will accomplish that and add hours of training in Iraq for an additional three Iraqi doctors and nurses! If you like, we'll even provide you with a free downloadable card that you can print and give to your dad this Father's Day!

How Moustafa and His Soccer Ball Captured Our Hearts

June 3, 2011 by Lydia · 2 Comments 

Moustafa’s parents spent years scouring hospitals across Iraq in search of someone who could fix their little boy’s heart.

Doctors eventually told them that he had no hope in his home country and that they needed to go to India, which meant Moustafa would never receive surgery since his parents could never afford to send him abroad.

But thanks to you Remedy Mission is here, and Moustafa is finally receiving his heart surgery!

In many ways, Moustafa is pretty similar to the other 6-year-old boys I know. His father, mother (who’s always by his side), and older brother all love him very much. He’s energetic and loves to play – especially soccer. But unfortunately I didn’t get to meet Moustafa at the park, or at his school. My first glimpse of him was in the children’s ward of a hospital awaiting surgery.

But all that has the chance to be fixed starting right now, and I’m eager to hear good news of a successful surgery. Keep reading for updates!

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At Long Last, Haydar is Finally Getting His Surgery!

May 29, 2011 by Alex · Comments Off 

When I met Haydar he was kicking a soccer ball around the hospital hallway. We played there in the hallway for quite some time, kicking and throwing the ball back and forth between the three of us. I made my arms like a hoop in front of me and Haydar would shoot the ball through them—he’s a pretty good shot for a 6 year old!

Because there are so many children here in need of heart surgery, and because cuteness and playfulness are not criteria we get to use in determining the order for surgeries (unfortunately), Haydar ended up being further down on the surgery list.

But thankfully, after patiently waiting in the hospital and always trying to show us how brave and prepared he was, Haydar is finally getting his surgery! We couldn’t think of a better way to wind down as we near the end of our trip—thank you for helping us bring the Remedy to Haydar!

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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…

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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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Yahya – One Week Before Surgery

July 12, 2010 by Sophia · Comments Off 

The hot desert sun beams down upon wreckage from the days of Saddam’s rule; and big houses, now broken down into cement blocks, line the dusty streets.

A modest white home is nestled in the midst of the rubble. And coming from the house were the sounds of dishes clanking in the kitchen, a TV blaring, a little boy’s laughter.

That little boy is 5 year-old Yahya, one of my favorites who is about to make the trip to Istanbul this Saturday for heart surgery. Much awaits Yahya. He is getting a new valve put into his heart, a new lease on his young life.

But for now, he is at home. While visiting him and his family in their home last week, I noticed Yahya in the living room playing a soccer-themed video game and giggling with his best friend, Ahmed.

Yahya loves video games. Normally very shy and reserved, his demeanor was relaxed and comfortable when he pretended to be the famous Argentinian soccer player, Lionel Messi. Yahya told his father that when he grows up, he wants to be Messi.

Yahya’s upcoming surgery gives us hope that one day he will overcome his disease and put aside his soccer video games in order to play like a real soccer star outside under the Iraqi sun.

Soccer balls and Staircases Reflecting a Renewed Childhood

July 1, 2010 by Alex · Comments Off 

When I visted Ahmad earlier this week, I was struck by two objects that embodied the effect PLC has had on the life of a child who has undergone heart surgery.

The first was the metal staircase leading up to their home on the second level of the block. This old staircase was red, rickety, and full of holes — a lot like Ahmad’s heart was a year and a half ago. Ahmad had one of the most complex cases of heart disease PLC has seen. His combination of defects turned his lips, hands and feet blue from lack of oxygen and assured that he would not have a normal or lasting childhood. But thanks to your support, commitment from his family and the skill of medical professionals in Iraq and Turkey, Ahmad could greet us at the top of the stairs with a smile on his face.

Ahmad’s medical story is not finished. He still has some blue to his lips and will need more surgeries down the line; but a second powerful image — that of a tattered and beaten up soccer ball — made me realize how much of an impact his first surgery truly had.

Worn out soccer balls are certainly not uncommon in Iraq, and I probably wouldn’t have given Ahmad’s ball a second thought if his mother had not pointed out that this was the same ball that was given to him by PLC just a year ago. Ahmad, a boy who had not been able to run last year because of fatigue from a lack of oxygen, had beaten his new soccer ball to shreds playing with friends.

This is the impact Ahmad’s surgery has had. He may not have a totally corrected heart yet, but he does have a childhood — full of running, playing, laughing, falling, scraping knees and wearing out soccer balls.

Passions Collide: An Intern’s Experience with Soccer and CHD

June 24, 2010 by Preston · Comments Off 

Two things I really looked forward to before coming to Iraq this summer were working with children who need heart surgery and playing soccer. While I have been here, I’ve been able to enjoy both of these passions, and a few times I’ve been able to do both at the same time.

While watching the World Cup match between France and South Africa this week, I met a man sitting next to me and struck up a conversation about soccer. After a few seconds of getting to know each other, I relayed to him that I was working for kids with heart conditions, and he told me that his cousin has two kids who have congenital heart disease. At that moment it occurred to me just how rampant CHD actually is in this country. In fact, this is only one of many times this same situation has occurred. Just a week before that, a friend and I walked into a tea shop to watch soccer, and I met two men who also have family members with the same problem of CHD.

A day or so later, after playing a pick-up soccer game with some local guys, the other male interns and I were called over so that the guys we played with could tell us about their cousins who have congenital heart disease. In each situation, we were able to connect our friends with PLC so their little cousins could receive help.

Two of my passions have collided —  a passion to play and a passion to help. Coming into this summer I knew about the problem of heart disease in Iraq, but being here has made the issue personal. There are so many kids that need heart surgery — so many that sometimes I cannot go through daily experiences (like watching a soccer game) without hearing about another child who needs surgery.

Congenital heart disease is embedded in life here, and soccer has been one way that I’ve seen the prevalence of it in the country. I hope that one day, with the help of your donations to PLC, many of these kids will be running, kicking and playing with a healthy heart of their own.

House Visit with Yousif Challenges PLC Intern

June 23, 2010 by Claire · Comments Off 

Last week a small group of PLC staff and interns visited Yousif in his village. As we wove through neighborhoods I noticed the muted and dull colors of the concrete walls, gates, roads and air. Amidst the tan, beige and dirt-colored village I kept seeing flashes of bright blues, oranges and reds — colors of the town’s vibrantly dressed residents behind gates and in shops. Their clothes fought my initial impression of his village. When we drove in, it almost looked like a ghost town, but once I started to see the villagers I saw the life and personality of the people shown through their clothing.

We arrived at Yousif’s home, and I was privileged to meet a woman whose personality quite literally burst through the front gate. Yousif’s mother had been summoned in from the field by her daughters because of our arrival. She flew in holding Yousif’s hand, wearing a work shirt and a pair of tattered juli kurdi pants — baggy pants traditionally reserved for men only. This woman oozed strength, confidence and know-how. She appeared as if she could build a house from the ground up, run a farm and raise her 10 children all at the same time. This was a woman I should learn from. There is a good chance I will never work as hard in a week as she does in a day.

Four of Yousif’s sisters brought us water, tea, grapes and cucumbers. Lessons in hospitality are not only something I could learn from this family but from all the Iraqi people. Despite the delicious drinks and snacks it was not long before we were itching to play with the kids. Little did Yousif know, there was a soccer ball in the car with his name on it. Yousif and his siblings had few toys and had to borrow a ball from kids down the street during PLC’s last visit. The ball was brought out and a game quickly ensued, but soon it came time to leave because Yousif’s mother had to get back to work.

As we were walking to the car Yousif’s brother ran out of the gate holding the soccer ball he thought we had forgotten. I was blown away. A child with very little access to his own soccer ball thought we had accidentally left behind this gift and instead of rejoicing and trying to keep it, he chased after us and attempted to give it back.

Time and time again I am humbled by the children and families we work with because of their dedication to hard work and hospitality. And through that dedication, I’ve seen that this family chose to focus on the vigor of life rather than on the fact that their family is dealing with a congenital heart defect.

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