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)

HOPE DENIED FOR PARWA

May 17, 2010 by Jessica · Leave a Comment 

This is not a very hopeful blog post, but one that is an everyday reality for many families in Iraq. Today I was sitting with Parwa’s family in their home when we learned she was deemed inoperable last week by an in-country diagnostic procedure. A wonderful team of American doctors came to our city last week and gave free check-ups and catheterizations (a procedure to assess how well the heart is pumping blood) to the children here. That part isn’t the infuriating part. What is infuriating is that this 11-year-old girl missed her chance at surgery; at a “normal” life – and that’s a chance she will never get again.

She should have had surgery 5-6 years ago. Even surgery one year ago may have saved her.

The hole in her heart (VSD) should not have been terminal. VSDs should not be giving death sentences to eleven-year-olds.

From the time I first met Parwa I have loved her. She is an amazing little girl, smiley and full of so much life. Unlike other children with heart problems, she isn’t blue, she goes to school, she plays with her brothers and sisters. If you saw her walking down the street you wouldn’t know that she is dying. And this is part of the problem. No one knew. No one thought to check.

This isn’t a country where most children go to the doctor for wellness checks at 2, 4, 6 months, and every year after that. This isn’t even a country where most children are born in a hospital (and those that are born in hospitals are discharged within hours in many cases without a chance to really assess much more than overt birth defects). Very few provincial doctors know how to check for these problems until it is too late.

In this case, even if they had discovered it at birth, there wouldn’t have been anything the doctors here could have done about it with the medical infrastructure such as it is.

And now it is too late for Parwa. But it is not too late for so many others. Days like today push me forward to walk into more homes and doctors offices and help these little ones who need help now.

Parwa isn’t the only child I saw today. I saw Bawar, a precious two-year-old going to surgery in July, playing outside with his older sister and brother. I also visited Yousif and his ten siblings in their small village house, complete with cows and chickens outside. Bawar and Yousif still have a chance. They are urgent and need surgery quickly. And the best news is that the only thing standing in the way is money. Their parents understand their problems, which led them to appeal to us for help to get to Turkey for their surgeries before it’s too late. Now we are just waiting on the funds.

Can you help?

We plan to send Bawar, Yahya, Leah, Nivar and possibly a few others to surgery on July 18, 2010. All donations will be used to cover their airfare, housing, food, and surgical expenses.

Successful Surgery for Deelan & Special Call for Lifesaving Funding

March 3, 2010 by Jeremy · Leave a Comment 

It was all smiles after another successful heart surgery here in Istanbul. Deelan’s surgery was a “total correction” – though he is still in ICU on a treatment of nitric oxide to bring down the pressure in his lungs.

In addition to being a by-product of cigarette smoke and rush hour traffic – not to mention a body building supplement – nitric oxide is used in pediatric intensive care. From the source of all online wisdom, Wikipedia:

The endothelium (inner lining) of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, thus resulting in vasodilation and increasing blood flow.

and

Nitric oxide is considered an anti-anginal drug: it causes vasodilation, which can help with ischemic pain known as angina by decreasing the cardiac workload. By dilating the veins there is less blood returned to the heart per cycle. This decreases the amount of volume that the heart has to pump.

Nitric oxide should not be confused with “laughing gas” – or, more officially, nitrous oxide – N2O.

Nitric oxide is also very expensive. In fact, we’ve had to use it already on Muhammed and Baroof. In addition to normal surgery costs (which is essential to repair the CAUSE of pulmonary hypertension), NO can undo the previous effects of the now-repaired cause. To fix the cause and not seek to reverse the effects is to leave the net outcome the same.

We spent $2,000 per child on nitric oxide, for a total of $6,000. As much as the surgery itself, this has really proven to be the stuff that saves lives. So today I’m going to ask that you find a way to give generously to the Lifesaving Nitric Oxide Fund to pay down Muhammed, Baroof, and Deelan’s additional costs and to pave the way for future children who will need this treatment.

Molecule of the Year (1992), Nitric Oxide

To save lives through the very specific provision of nitric oxide, please contribute your desired amount below. One container of nitric oxide costs us approximately $2,000.

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.

Deelan is Taken in for Time-Sensitive Surgery

March 3, 2010 by Jeremy · Leave a Comment 

Deelan and his mom were a little unnerved this morning as they waited – and were eventually taken in to the operating room – for Deelan’s surgery to repair the massive hole in his heart and thereby decrease the life-threatening pressures in his lungs.

Meanwhile, back in Iraq, Deelan’s family waits with a lot of anxiety over the next few hours. This thing they’ve been longing for; this thing they’ve been working for – this surgery – is now a great unknown. It still stands as a beacon of hope for them, but now that it’s upon them, the realities of the risks set in in a way that was previously unknown and unanticipated.

Deelan should be out of surgery in 4-5 hours. More to come…

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.

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 Muhammed (Twitter: @MuhammedAdnan)

February 24, 2010 by Jeremy · Leave a Comment 

Muhammed’s presence in our life is a testament to the way the Preemptive Love Family Services Team has lived out our Core Values – namely, our pursuit of excellence (or constant improvement) and the way we seek to provide whole solutions for whole people. But all that sounds a little vague, so let me break it down…

In February 2009 a Kurdish soldier knocked on the door of our office. Though I hadn’t done anything wrong, I was sure I was about to be hauled in to give an account for something ridiculous. Thankfully, I was wrong. His name was Hywa and his daughter needed a life-saving surgery…. very urgently. We fast-tracked his family to surgery, but unfortunately he had already missed the optimal surgery window for his daughter when he first appealed to us. His little baby died in March 2009.

But Hywa and I formed a friendship that was somehow wrapped up in our mutual efforts to save his child’s life. When we put Honyar on that plane to Istanbul there was an initial feeling that we had both succeeded. And as I stayed back with him in Iraq, we cried together, somehow feeling like we had both failed that day she died. Of course, it was not the same grief for me as it was for him, and I would dishonor him to imply otherwise. But we celebrated, mourned, and grew together.

A few months later Hywa referred his friend Sami to us because Sami’s boy Danar was dying from a similar heart defect. We sent Danar to surgery in January 2010 and Danar can be seen doing really well after his surgery in our video of follow-up echos a few days ago.

After Danar returned from surgery, his father, Sami, referred Adnan to us because Adnan’s son is similarly facing death from extremely high pressure in his lungs as a result of two large holes in his heart.

Call it the “butterfly effect” or “serendipity” or “Providence” or a “job well done.” I’m really proud of our Family Services Team and all the work they’ve done to leave a lasting impact on families like Hywa, Sami, and… hopefully… little Muhammed’s family.

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.

*In accordance with PLC’s desire to lend a hand-up by avoiding strict hand-outs (when possible), Muhammed’s family told us they would sell their car to help their son and ultimately gave $6,500 towards PLC’s highly-discounted surgery prices.

Baby Muhammed Adnan Needs Urgent Surgery

January 23, 2010 by Jeremy · Comments Off 

This little guy, Mohammed, came to see us in our office a few days ago (with his parents… not by himself). For a very sick baby, he is remarkably smiling and happy. He was such a joy to have in our office; brightened our day and inspired us to keep pushing forward in our life-saving, hope-giving work!

His parents are friends of little Danar Sami‘s parents, whom we sent to surgery a few weeks ago. Mohammed’s father told us in our office last week that he will do whatever he can and is prepared to give all he has – $5,000 savings – to send his son to his highly urgent operation before rising pulmonary pressure leave him inoperable.

	Mohammed is scheduled for surgery in the next few weeks. We are urgently collecting money for his surgery because doctors say that waiting any longer may leave him inoperable, facing imminent death. What a chance to make a profound difference in the life of a child and his family!
	ADOPT MOHAMMED’S HEALING Donate the amount of your choice to Mohammed by entering it in the field below. All donations help the Preemptive Love Coalition send Mohammed (and any others in his group) to life-saving heart surgery. Donation:

Zana Plays Football Two Months After Returning From ♥ Surgery

June 2, 2009 by Jeremy · Leave a Comment 

In February Zana entered the Anadolu Sağlık Merkezi hospital in Istanbul, Turkey and underwent one of the most amazing, dangerous heart surgeries out there. Today, thanks to our partners at Kurdistan Save the Children, all of your kind Buy Shoes. Save Lives. purchases, and donations to PLC he is playing football like all the other kids in his neighborhood with barely a care in the world.

All these pictures are courtesy of the wonderful pro bono photographer Matt Addington and PLC’s Followthrough program, whereby we make sure that kids are not sent to surgery only to return to Iraq and be forgotten.

Heran Goes Into Surgery Looking Blue

May 28, 2009 by Jeremy · 41 Comments 

Heran on her way into surgery with very low blood-oxygen saturation.

She has emmerged from surgery and is recovering in ICU where her blood-oxygen levels are now at over 90%. That – and all other signs – say that she is doing well!

Photo: Matt Addington

Ahmad Out of Surgery! No More Blue Skin! All is Pink & Healthy!

February 17, 2009 by Jeremy · 1,042 Comments 

Ahmed is out of surgery. His oxygen levels are already up by 25%. His future is hopefully less blue and a more healthy pink. His dad is crying tears of joy.

Dr. Çiçek at the Anadolu Sağlik Merkezi was clear that this is not a long-term, fully corrective solution; but this first surgery should allow him to finally live long enough to receive the staged surgeries he’ll need over the coming years to actually live a fully functional adult life.

We’ll update with more information as soon as we know it.

Follow Ahmad’s daily updates on Twitter or via his RSS feed.

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.

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