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?"


----------

 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)

Jeen Mustafa is Leaving for Surgery on Saturday

July 15, 2010 by Jeremy · 1 Comment 

Meet Jeen Mustafa. Jeen is currently living with Atrial Septal Defect (ASD), which affects the two upper chambers of the heart. Her disease creates a hole between the two upper chambers of the heart, mixing the blood going to the lungs with the blood going to the rest of the body. Because of your financial help, Jeen is leaving for surgery on July 18 along with 4 other children with congenital heart disease. Jeen will be receiving a non-invasive surgery through catheter, which also significantly reduces the danger of the procedure.

Follow Jeen on Twitter: @JeenMustafa. Subscribe to Jeen’s updates via RSS HERE.

Two Weeks Away From Surgery, Leah Continues to Grow and Develop

July 5, 2010 by Esther · Leave a Comment 

from Preemptive Love on Vimeo.

In a week and a half Baby Leah goes to surgery!

Those words bring so much joy to my heart because they signify the new life that successful heart surgery will give Leah.

Since the last time that we visited Leah, she has continued to grow and develop – rolling over with ease, bouncing off her mother’s lap, waving at others and attempting to hold herself up on her hands and knees.

This little girl, whose birth defects have threatened to steal her life away, now has the opportunity to have that life transformed because of the combined efforts of Turkish heart surgeons working to restore peace with their set of surgical tools along with the willingness of donors like you.

Leah is one of 4 Iraqi children that will be traveling to Turkey on July 18 for heart surgery because of your involvement and desire to combat the unnecessary deaths of children born with congenital heart disease.

Click HERE to follow Leah Ibrahim on Twitter as she gets ready for surgery.

Baroof’s Scar Stands Against Kurdish Terror and Turkish Oppression

July 4, 2010 by Jeremy · 1 Comment 

The photo above tells the story of an extremely different child than the one we met in March right before boarding a plane to Istanbul, Turkey. Three months ago Baroof received a rare and complicated surgery for his age – a surgery that ultimately has spared his life and ushered in a new season of joy and obvious strength.

But basking in this season of salvation isn’t quite as easy as it might be for other children in other places. Baroof’s family lives on the Iraq – Turkey border, where for years Kurdish separatist rebels (members of the Kurdish Worker’s Party or the PKK) have been mounting attacks against the Turkish government in pursuit of an independent Kurdish nation. In response to the PKK’s terrorizing of Turkish civilians and military personnel, the Turkish government often responds with a blunted hammer where a precision tool might have been more effective.

The activities of the PKK claim to be a response to Turkish oppression. And Turkish heavy-handedness claims to be a response to Kurdish terrorism. And thus, the cycle continues.

Because of this cycle, Baroof and his family have grown up with a relatively monochromatic view of Turks and Turkey – such as “Turks are the oppressors who kill our Kurdish cousins in Turkey and cross international borders into Iraq to kill our family here as well” or something similar.

In March, we helped throw a splash of color on that single story. What was once a black and white issue has been somewhat mitigated by the kind actions of Turkish doctors who give generously of themselves and their skills to serve children like Baroof. The kindness was not lost on Baroof or his family. Now back in Iraq after surgery, they express their gratitude to Kurds around them for the Turks who saved their son’s life, thereby pushing back a single story about Turkish oppression and easy justifications of Kurdish rebellion.

Some of Baroof’s tribal members and distant cousins have died at the hands of the Turkish military. Others likely bare the scars of near-misses and raids gone wrong. But Baroof’s scar is a line of love from your heart, through Istanbul, Turkey, all the way to the border of Turkey and Iraq.

Your financial gifts have enabled Turkish surgeons to write new language into the region.

Baroof starts school again in September. Because of you, his desk will not sit empty this year. Because of you, his Kurdish friends – who might otherwise be enticed into the ways of PKK terror – will constantly contend with the scar on his chest and the technicolor story it tells.

Bawar Plays Football While We Visit Inside About His Much Needed Heart Surgery

May 13, 2010 by Joshua · Leave a Comment 

It looks like we found Bawar in time… still playing football! But before his window of time runs out, we plan on taking him to a much needed heart surgery in Istanbul, Turkey.

Baby Leena Leaves Iraq for Urgent Surgery in Turkey

April 14, 2010 by Jeremy · Leave a Comment 

It was about mid-morning on Sunday when Leena’s dad came into our office, frantically looking for help for his daughter who was dying before his eyes from her congenital heart defect.

We contacted our partners in Istanbul at the Anadolu Medical Center and they concurred: it might be too late for Leena, now 50 days old, but if there was any remaining chance she should come immediately.

With unprecedented speed we worked with Leena’s father and their extended family to get Leena to surgery. The family and friend network rallied quickly sold their car and rallied with a total of $10,000. Within just a few hours we were able to get our local staff, Leena, and her mother on the very last seats out of Iraq on Tuesday’s flight to Istanbul.

The picture above is Leena’s last moments with her father before leaving him to go back to the village where he is 8 year old Mohammed Star’s elementary school teacher, whom we sent to surgery in November 2009.

Are you looking for a way to get involved? Let us suggest the following three actions: - Sign up for our newsletter to stay apprized of news and deals on stuff you can buy to save lives in Iraq. Name: Email: - Send out a “tweet” or a message about us on Facebook, suggesting your friends check out these dear Iraqi kids. - Give your time or money. Both save lives! For volunteering, send an email to cody@preemptivelove.org. For life-saving tee shirt, shoes, and scarf purchases, head over to our Buy Shoes. Save Lives. store for our 25% OFF SPRING SALE. For donating money, please use the fast and simple form below.

Meet Deelan (Twitter: @DeelanKameran)

March 2, 2010 by Jeremy · Leave a Comment 

Deelan arrived in Istanbul, Turkey last night on a plane from Iraq thanks to Atlasjet Airlines and the generous support they’ve offered to help us get this February group to surgery. If you are one of our summer interns, we highly recommend that you choose Atlasjet to fly into Iraq.

Our Family Services Director, Jessica Courtney, (who, if you’re keeping score at home, is also my wife) accompanied Deelan, his mother, and one other family to Istanbul last night to round out our February/March group of surgeries.

Special thanks to the Alice Abdi at the Anadolu Medical Center for the continual support, for staying late at the hospital to receive these dear kids, and for sending – as always – a special private van to pick up these fearful families. This keeps our costs low, speeds up our travel, and most importantly, shows the kind hearted desires of so many here in Turkey as they reach out to Kurds and the rest of the people of Iraq in providing these deeply discounted, life-saving heart surgeries.

Deelan is not doing well at all – crying nearly constantly and facing down dangerously high pulmonary pressure in addition to the huge hole between the lower two chambers of his heart .

Deelan is scheduled for surgery on Wednesday.

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

*In accordance with PLC’s desire to lend a hand-up by avoiding strict hand-outs (when possible), Deelan’s family contributed $5,000 towards PLC’s highly-discounted surgery prices.

Dua Looking a Little Unsure as She Waits to be Taken to Surgery this Morning

February 26, 2010 by Jeremy · 1 Comment 

There’s not much more to say… this picture pretty much captures the uneasiness of this part of the journey. So much hope, fear, trust, and distrust is inherent to the moments right before surgery.

Thanks for joining Dua and her family as they entrust her into the hands of the Turkish team… from their perspective, this is the only chance she’s got. And thanks for all you’ve done to fund her surgery to get her to this point.

Dua’s name means prayer. So as we all remember Dua right now, we honor her parents and honor GOD by entrusting her life to GOD in prayer. More to come after she emerges from surgery…

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

Total Correction for Muhammed!

February 25, 2010 by Jeremy · Leave a Comment 

Doctors accomplished the total correction they were hoping for with Muhammed. But he came to us with extremely high pulmonary pressure (in his lungs) so the coming days in ICU will be incredibly important.

Special thanks to Erica Fischer of EMF Images for partnering with us to save Muhammed’s life. At the suggestion of EMF’s Erica Fischer, Cameron and Ben (left) donated the sitting fee for their engagement pictures to the Preemptive Love Coalition to help fund Muhammed’s surgery. This ongoing partnership with EMF promises to save a lot of lives in Iraq and engage the hearts of many who thought they were just signing up for EMF’s great photography!

We know there are hundreds of you out there doing amazing stuff like this to save lives. Sometimes we just don’t know what you’re up to! Contact us.

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

Meet Dua (Twitter: @Dua_Arif)

February 24, 2010 by Jeremy · Leave a Comment 

We met Dua and her family through a partnering organization on the northern Iraq-Turkey border near the area where Dua lives. As a result, we’re just now getting to know her (whereas we’ve had relationship with some of these other families for months).

Dua was diagnosed in Iraq with “tricuspid atresia” – a defect that only accounts for 1-3% of all congenital heart defects. In short, this defect means there is an absence of the tricuspid valve. From Wikipedia (because a lot of other sites prohibit quoting their information!):

Therefore, there is an absence of right atrioventricular connection. This leads to a hypoplastic (undersized) or absent right ventricle. This defect is contracted during prenatal development, when the heart does not finish developing. It causes the heart to be unable to properly oxygenate the rest of the blood in the body. Because of this, the body does not have enough oxygen to live, and steps must be taken to keep the child alive.

And for bonus points, you can click here to read more on the Fontan procedure for which Dua is a candidate (though her operability is still undetermined).

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

*In accordance with PLC’s desire to lend a hand-up by avoiding strict hand-outs (when possible), Dua’s family worked with the regional government and with personal and government funds contributed $6,000 towards PLC’s highly-discounted surgery prices.

Family Followthrough in Iraq: A Day of Post-operative Testing on Former Heart Surgery Recipients

February 22, 2010 by Jeremy · 2 Comments 

Last week we were honored to have some of the excellent medical staff from the Anadolu Medical Center in Istanbul, Turkey make the trip to our office in Iraq to work with us on a few current and future initiatives. Among our agenda for the week:

• * Analyze the current adult cardiac center’s suitability for a pediatric surgical mission in the coming months
• * Enjoy a home-cooked banquet with PLC Alumni Families (former surgery recipients and congenital heart disease over-comers)
• * Speak with local media about the need for cooperation between the Turkish, Kurdish, and Arab communities
• * Test and triage a list of 40-something candidates for 2010 surgery
• * Perform follow-up echo tests on some of our most serious 2009 alumni children

The video above represents one of our agenda items for the week! In coming days we hope to post a photo narrative about the amazing alumni banquet and a story from local media about the Turkish delegation and PLC’s peacemaking agenda with them.

Don’t forget to push PLAY above to watch hope and life in motion!

Filed Under: Ahmad Bakhtiyar, Anadolu Sağlık Merkezi, Danar Sami, Development, Family Participation, Go Blog It!, Heart Surgery, Heran, Lawaran, Mohammed Umed, News, Our Kids, Partnerships, Peacemaking, Ranu Bahadeen, School, Surgery Updates, Volunteers, Zana Tofiq Tagged: Arab, CHD, congenital, Development, disease, health, heart, Iraq, Kurd, Surgery, Turkey

« Previous Page — Next Page »