Samaritan's Purse

By Jeremy Shoham, ENN

The ENN recently interviewed Mary Lou Fisher, Health and Nutrition Advisor for Samaritan's Purse, based in North Carolina, USA. Mary Lou started her professional life as a registered nurse. In 1996 she received a degree in advanced practice nursing from Johns Hopkins University (JH) and continued her career as an adult nurse practitioner in the emergency department. Having always wanted to serve overseas, Mary Lou took every opportunity for short-term medical work with Samaritan's Purse while still working for JH who allowed short secondments. Memorable early experiences in the Balkans include trekking over the Albanian Alps with Kosovars wishing to return home. While there, she also worked in a MASH for Albanian Kosovars and a western-style emergency medical department in Gjakova. Her other short-term assignments included work in Afghanistan and western Darfur. In November 2006, she became the fulltime International Health and Nutrition Advisor for Samaritan's Purse.

Children in a village in Guatemala, pictured by Mary Lou's colleague whilst "scouting" for acute malnutrition

Samaritan's Purse was founded in 1970 by Dr. Bob Pierce who, 20 years earlier, had created World Vision. Those of you who know your Bible (not me) will realise that the name Samaritan's Purse comes from the New Testament parable about someone helping an injured stranger by the road side whom others had passed by. Mary Lou described how the story symbolises the importance of helping absolutely anyone in need no matter who that person is or how critical you may feel about them. Samaritan's Purse is committed to helping anyone in need. As representatives of the Christian faith, staff understand the importance of following Jesus' command to love one's brother (or sister).

Samaritan's Purse began as a strictly emergency- focused organization, providing relief in the form of feeding programmes, housing, water, and sanitation. However, over the years the organization has also branched out into development and will often remain in-country to establish longer-term infrastructure and services after an emergency intervention.

Mary Lou with one of the women helping in the SFP in Kenya.

The types of feeding programmes that Samaritan's Purse implements include general food distributions and selective feeding, i.e. supplementary and therapeutic feeding programmes. After the NATO bombing in Kosovo ended, Samaritan's Purse distributed over 4,000 loaves of bread daily. While in Afghanistan, they fed hundreds of men involved in reconstruction. Skip back one decade and Samaritan's Purse distributed food and livestock in Bosnia and food and medical supplies in Mogadishu. More recently, feeding programmes have been established in Darfur. In line with the shift towards more developmental programming, Samaritan's Purse is now looking at setting up a Child Survival project in Niger and also has a grant proposal with USAID and WFP to implement nutrition and health care programming, including school feeding, in Guatemala.

Views on nutrition are evolving within Samaritan's Purse. Mary Lou believes that the recent Lancet nutrition series is very timely and really highlights the need to refine programme focus on children two years old and under to make sure they get optimum nutrition. This is especially important given the risks of chronic illnesses associated with overfeeding after the age of two. The series also highlights additional interventions for maternal and child undernutrition and survival, including international action.

In line with many other humanitarian agencies, Samaritan's Purse is moving away from the centre-based model for treatment of severe malnutrition to community-based care, e.g. community management of severe malnutrition (CMAM). Another shift is employing more qualified staff, like nurses with public health degrees and experience. Samaritan's Purse has learned that "one answer does not work for all situations and that you need good assessments everywhere you work to make sure you get context-specific solutions." Other lessons include the value of maximising the involvement of national staff and the importance of networking by attending nutrition sector meetings.

The ENN asked Mary Lou to talk about her best and worst programme experiences. Her work in Hamish Koreb, a village in eastern Sudan with a high rate of malnutrition, fitted both bills. The area is populated by the Beja, a tribe that had previously been pastoralists. Many of the residents had lost their livestock because of conflict and were forced to live as virtually destitute IDPs. Samaritan's Purse became involved in a number of sectors between 2004 and 2006, including food, medical, water, and agriculture programming. The organisation set up its main office across the border in Asmara, Eritrea, and at one time had 45 Eritrean and expatriate staff living in the Hamish Koreb compound. The programme also established a nursing school for men and women. Through this project, illiterate women, with no previous schooling, were successful in learning disease prevention and treatment. In order for the Beja women to understand, lessons were verbally translated from English to Tigrinian to Arabic to Bedouit with the help of three translators. The students were given oral examinations of the material and did surprisingly well. Sadly, following the signing of the peace agreement between the SPLA and the Sudanese Government, Samaritan's Purse was asked to leave the area. The Beja appreciated how staff were respectful of their culture and wanted the organisation to return. Samaritan's Purse is now working to re-establish this programme. Recent assessments have shown that the situation has more or less gone back to 'square one' with high rates of undernutrition, especially among women and children.

Samaritan's Purse gets 95% of its funding from private donors and foundations. It is a faithbased evangelical organisation and a number of employees are the children of missionaries who grew up in underdeveloped countries. Although most of the work is standard emergency-type programming, Samaritan's Purse is also involved in building and repairing churches destroyed during conflict.

Mary Lou feels that Samaritan's Purse has many positive qualities. They always do what they say they are going to do even when faced with danger. She describes the valour of some staff as "beyond understanding" because they are willing to work in places that many others might not countenance. She also feels that when Samaritan's Purse "sets up shop somewhere," everyone knows about their work. When she is able to run for a bit of recreation while in-country, she often encounters local citizens who recognize her and know about the organisation's work.

Samaritan's Purse is working to more effectively document the impact of the work being done. The organisation is also looking to expand into more countries.

It is clear that the work of Samaritan's Purse is being increasingly recognised by fellow nongovernmental organisations, governments, and other agencies as staff participate in international forums and networks. As a result, they are becoming more involved in cutting-edge programming approaches and issues. Mary Lou said that they are using models such as Positive Deviance (PD) Hearth and CARE Groups for interventions, while Lot Quality Assurance Sampling (LQAS) may also be a way forward in assessment.

After thanking Mary Lou for the interview we agreed that we would look out for each other the next time one of us was out running along the banks of the Nile. I got the feeling that she might be hard to keep up with.