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)

“Thank you for saving me!”—Ali Abdul, 12 Year-Old Future Heart Surgeon

January 21, 2012 by Cody · Leave a Comment 

If you’ve been following Ali’s story, you’ll be happy to know he is doing extremely well! Remedy Mission VIII is almost at an end, but Ali’s last words for the camera were expressions of gratitude—thank you for saving him!

In case you missed them, go check out more photos/videos of Ali and his friends on our Twitter stream.

Photographer Farewell

November 22, 2011 by matt · Leave a Comment 

Friends, today is a sad day. After 7 months of working together, we’re saying goodbye to our photographer, Lydia O’Neil. She’s headed home to finish her last semester at the Corcoran College of Art + Design.

If you’ve spent time exploring any of our online real estate, you’ve probably admired her photos. We’ve received countless messages from people saying how much they enjoyed her Daily Squares on Facebook, her photos of children, and her work on our Flickr stream.

So, while we’re sad to see her go, we’re excited to see what her future holds. If you’ve admired her work, head over to her personal website and tell her so. I’m sure she’d appreciate the encouragement! You can also follow her on twitter here.

Goodbye, friend! We miss you already and hope, insh’allah, to work with you again soon!

Much love,

The PLC Staff

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

February 22, 2011 by Cody · 1 Comment 

16 Children

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

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

16 Families

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

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

16 Stories

That’s how many stories you’ve rewritten!

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

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

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

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

We love doing this with you!

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

Our Partners

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.

Sara Enjoys a Visit from U.S. Supporters Who Funded Her Surgery

March 9, 2010 by Jeremy · Leave a Comment 

For more photos of the girls time in Istanbul, Turkey, please visit our Flickr site.

As cute as the babies are, we do enjoy interacting with these older kids. Watching them work through their fear, and seeing them come into their own in a foreign culture, is a real joy. Plus, it seems like the “mark” we’re leaving for life will be more profound for these adolescents.

If you’ll remember, Sara’s family comes from Kirkuk, Iraq. One of her cousins left Iraq over ten years ago and currently lives in Istanbul. So we’ll be discharging Sara into the care of her cousin this week so he can show her the sites and so they can reconnect a bit as a family.

But before she leaves, we were honored to host one of our biggest advocates and long-term supporters, Chelsea Pershall (center), and two friends (Erin [left] and Ashley [right]) for Spring Break in Istanbul. They came specifically to meet Sara, whose surgery they funded through a widespread grassroots effort on the Baylor University campus via FWCM.org.

Sara’s family was so grateful to meet these three girls and beyond the life-saving money they represent, found a lot of comfort from hours of broken English conversations and card games.

Do you know someone who might be interested in joining us for a summer of this kind of work in Turkish hospitals and Iraqi homes? Click here to consider our Summer Internship.

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.

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.

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.

The Great Eight (Taban)

February 12, 2009 by Jessica · 4 Comments 

After only 2 weeks in Iraq, working with families who’s children need heart surgeries to grow into adulthood, it was an exciting day to come face to face with two of these families and their children. Both families, whose children are 11 and 13 years old have known since birth that their children have serious heart conditions.

It was wonderful to be the bearer of such great news and tell Taban’s family, who has been waiting for 13 years to find a way to help cure their daughter, that she will be able to leave for surgery on Sunday. In just a few short days she will be on her way to Turkey where she will receive the heart surgery she desperately needs. I have been very touched by the kindness and devotion of these families to do whatever it takes to help their children get the surgeries they need. They are willing to entrust their children, their futures, and even invest their hope in us, The Preemptive Love Coalition.

As we shared several glasses of tea with them, they took the time to welcome me to their country and their village and thank me for leaving my home in America to come and help their children. Although these two children urgently need surgery, the Doctor reviewing their cases is very hopeful that their surgeries will be successful.

Not all of the children we have seen this week have as much hope for a full recovery, or even that they are eligible to receive surgery. And even in the midst of being the potential bearer of wonderful or terrible news for these families, I would not choose to be anywhere else in the world than here in Iraq sharing in the joy,

sorrow, hope, pain, and healing of these children and their families.

Follow us on Twitter

February 3, 2009 by Jeremy · Leave a Comment 

The Preemptive Love Coalition has been too busy saving lives to maximize our Twitter account. But we’re ready to dive in fully!

With regular tweets from around the world [Texas, California, Iraq, Istanbul & Ankara (Turkey)] plus travel tweets as we hit up Europe & the UK for more preemptive love for people of Iraq, we hope we can connect with you and learn from you in our collective effort to increase dialogue – and love – between international communities at odds.