A man in a hotel cafe in Iraq asked Jeremy Courtney a simple question: Could the American help his cousin who had a hole in her heart?

Courtney, who moved with his wife, Jessica, and his toddler daughter, Emma, to Iraq around New Year’s Day 2007, was not a doctor, nor did he have any medical knowledge. The family, which would later that year include son Micah, had come to Iraq to work with an international humanitarian organization that was helping orphans and widows.

Soon, Courtney, who graduated from Leander High School in 1997, was learning about the lack of surgeons in Iraq who could do this procedure, the number of kids born with this birth defect in Iraq and the system of patriarchy that decides who receives surgeries.

One girl’s need led Courtney to start the Preemptive Love Coalition, a nonprofit organization that since 2007 has helped more than 1,000 Iraqi children get life-saving heart surgeries and now trains Iraqi doctors to perform the surgeries.

"He’s just a normal guy," says Josiah Sternfeld, who met Courtney when they were in eighth grade. They later played in the high school band together and have remained friends. "He’s just a guy who grew up in Leander, who wanted to do something in the world and make a difference."

Developing leadership

Courtney, 35, moved to the Austin area in fourth grade. His family was active in the Baptist church, in which his grandfather and father were ministers. The church and those values shaped his belief in preemptive love — whenever there are dark times or conflicts, love is always the answer.

The band shaped his leadership skills. Under director Dennis Hopkins, Courtney was a squad leader for groups of students. He played saxophone.

"He was always a focused kid," Sternfeld says. "He was very focused on his faith, doing well in school and being the best he can be."

Courtney took his role in the band seriously, and Hopkins knew he could count on him, but Courtney also would inject humor when things got tense, Hopkins says. "He had this special way."

"I knew he could do anything," Hopkins says. "He had a plan to reach those goals…. A lot of people have potential. He’s someone that is realizing his potential."

Terrorism at home

Sept. 11, 2001, forever changed Courtney’s life, but not in the way you might think. He didn’t lose someone in the tragedy. He didn’t join the military.

Instead he began to question what the proper reaction to terrorism was and whether war was the right answer. "There was so much national pride around the idea that we would strike back and we would win," he says. A lot of people got caught up in that, he says.

While Courtney was getting his master’s in theology at Baylor, he and his wife, Jessica, joined First Baptist Church Woodway. Some of its members were like-minded in their questioning of the United States’ involvement in Iraq and Afghanistan, the growing bigotry and hatred toward Muslims and whether a desire to kill America’s enemies was defensible from a Christian perspective. "The community was asking … whether it was truly Christian to behave that way," he says.

Even as his master’s education was ending, Courtney didn’t know what he wanted to do with his life. "There was a sense that I would follow in the family business," of being a Baptist minister, he says. "But that wasn’t really my desire."

Soon Courtney and his wife wanted to "put feet" to this question of the appropriate response to terrorism. He took exploratory trips to Iraq to see if they could actually move there. Each time, he would tell her that the need was so huge, but, "I don’t think we can live there," he says. "She had this real sense that this is what we need to do. She had a sense of a calling and a conviction."

After they got to Iraq, they began to understand what living there would mean: three hours of electricity a day, and water had to be pumped to the houses and stored in containers.

Courtney says they realized that he was right and she was wrong about their ability to live there. "It was extremely difficult," he says. "We didn’t know if we would survive as a family. Would we make it through?"

Growing up in Iraq

For his children, who are now 9 and 7, there is a bit of an odd juxtaposition. They are growing up in a community where it’s nothing to have kids go to the store by themselves for bread or walk to a friends’ house by themselves. Parents don’t hover or worry if their children are out of their sight.

The Courtneys understand some Arabic, but none of them are fluent, and they are still outsiders. They have deep respect for their Muslim neighbors.

When they visit the U.S. to see family, the kids notice the anti-Muslim rhetoric. "That can be very confusing to them," Courtney says. "They don’t know Muslims to be the bad guys. They know far more Muslims than Christians. Muslims are normal people, the bus drivers, the tax drivers, the shopkeepers."

Loving first

Living in Iraq, they have had to embody preemptive love. Their mission "dares to go into the hardest and darkest places and dares to stand up to ISIS, not with bigger guns but with a bigger vision."

It is what guided Courtney as he began to navigate how to get this one child a heart surgery, and it is what continues to guide him. Preemptive love is the reason the organization is much bigger than him, even though he is the face behind it and the author of the 2013 book about the coalition, "Preemptive Love: Pursuing Peace One Heart at a Time."

Every day he is reminded how incredibly naive he was when he started Preemptive Love Coalition and how much of a gift that naivete was. "You do it not being aware of the difficulty of what it’s going to take," he says. "If we knew what it took, the social issues, we would never choose to engage." He didn’t understand the foreign policy or the political issues or the class issues and patriarchy, some of which are new, some which stretch back centuries.

"Providing surgeries for kids, that was the problem I thought we were solving," he says.

What he soon realized is Preemptive Love had to do so much more.

Making surgeries happen

Courtney soon learned that it wasn’t just one girl who needed a heart surgery. Some children whose parents survived the 1988 chemical warfare attack by Saddam Hussein on the Kurds were born with these defects. Other children who lived in areas that sustained heavy bombardments of weapons that used depleted uranium during the wars also have the defects. United Nations sanctions that happened between Iraq’s invasion of Kuwait and the fall of Saddam Hussein meant that many pregnant women didn’t get proper nutrition, leading to the defects.

He soon learned that there is evidence that Iraqi children in some cities have 10 times more heart defects than the world average. There also weren’t enough doctors and facilities trained to do the surgeries. Thousands of children were dying before they could get the surgery.

The initial plan to fund the surgeries was to sell Kurdish shoes made by local craftsmen to Americans. Courtney used his and Jessica’s life savings to buy shoes from local merchants and then posted photos of the shoes online with the banner "Buy Shoes. Save Lives." The orders came rolling in. The organization had a revenue source.

Preemptive Love also required families of children getting heart surgeries to help offset some of the cost, not to make it cost-prohibitive but to make sure families had buy-in.

Courtney began networking to figure out where to send the children because of the lack of trained Iraqi doctors and hospitals.

The first answer came in Israel. It was a huge leap. Families didn’t want to send their children to Israel, but this was the solution that Courtney could find. Most families chose their children over prejudice, but they would often tell people their children were being treated in Jordan.

After about a year, the situation with the Israeli hospital changed, and Preemptive Love had to find a new hospital. It found a connection to Johns Hopkins Hospital in Turkey. Historical unrest between Turkey and the Kurds meant this also was not an easy answer for many of the Kurdish families in the program, but was a much better solution for Arab families.

Bringing surgeries back to Iraq

While having the surgeries in Israel and Turkey did have the positive effect of changing the way families felt about the people of those countries, Courtney realized in 2012 that he had made a mistake. By not training more Iraqi doctors and hospitals, they were only putting a bandage on the problem. "It was a divestment in Iraq’s future. Money should be spent building up Iraq rather than sending these kids to other places," he says.

So he started searching the Internet and found the International Children’s Heart Foundation out of Memphis, Tenn., that was willing to brave bombs and bullets and come to Iraq. Together they started Remedy Missions to bring U.S. doctors to Iraq to teach Iraqi doctors and hospitals how to do the surgeries and care for the kids post-surgery.

Easier cases are done by Iraqi doctors to help boost doctors’ confidence levels, but the riskier surgeries are done in Iraq by an international team of doctors from International Children’s Heart Foundation, For Hearts & Souls and Novick Cardiac Alliance.

By 2010, the shoe business was beginning to wane and Preemptive Love turned to a new model. Donors give money, which then prepays the cost of the surgery as well as covers the expense of bringing in Western medical experts to Iraq. The Iraqi government eventually reimburses Preemptive Love the cost of the surgery, and then Preemptive Love is able to fund another surgery. The cost of the surgeries depends on the hospitals, so sometimes Preemptive Love loses money, sometimes it makes a little. It evens out.

Preemptive Love also has raised about $500,000 through the book.

The Courtneys lived off donations from friends and family until 2012, when Preemptive Love became financially solvent enough to be able to pull money for salaries.

Going into places where others won’t

In the past year, Courtney has watched the climate of Iraq change as the Islamic State group has gained more and more control over the country. Jessica Courtney is always encouraging her husband to go to some of the most dangerous places. They continue to be committed to working in Fallujah, a place where Courtney says "American colonels are saying no Americans will ever be welcome again."

Government officials have helped them come into Fallujah at night when it was too dangerous to go in the day. Jessica, he says, is "always saying, ‘You have to go. We didn’t move to Iraq so we can play it safe.’ We are constantly checking in to evaluate our family values." She’ll tell him, "Should we not go to Fallujah because it’s too dangerous? Let’s choose the bigger vision." "She’s very much the partner pushing me out the door," he says.

He has learned some important lessons working in Iraq that he’s now carrying over to places like Libya, the Balkans, Ukraine and Russia. He would like to expand beyond heart surgeries but hasn’t found the right medical partners to do the training.

One important lesson is not to put all his eggs in one basket. Allies sometimes turn. It’s a very nepotistic society in Iraq, and often you’re not sure where allegiances are. It’s very easy to make enemies, he says. "We have to continually provide more good than anyone can say bad about us," he says.

That’s part of the bigger picture of Preemptive Love. "We talk about heart surgeries and cardiac care," he says. "But the greater agenda is how to love in a time when no one else wants to love."

"We’re not just maintaining or holding ground," he says. "We’re driving back the darkness. We have the capacity to overrun evil."