August 26, 2013

Food Systems and Patient Care: Notes from a Dietetic Intern (Part 2)

Marie Spiker

Marie Spiker

Dietetic Intern

Center for a Livable Future

marie_food depotAs a student in the Coordinated Masters Program in Dietetics at the Bloomberg School of Public Health, I’ve had the opportunity see firsthand how the nutrition status of patients I meet in the clinical setting is influenced by the broader food systems in which they participate. During my clinical rotations at Bayview Medical Center, I’ve spent most of my days learning how to manage patients’ nutrition-related care during hospital stays. While some patients have very low nutritional risk – perhaps they fractured a bone and are otherwise healthy – many patients are of special concern due to difficulties in controlling their blood glucose or high risk for future cardiovascular events. We try to equip these patients with the information they need to make healthy food choices, but once discharged they return to a reality where the availability of healthy choices and the cost of food can be major barriers to their wellbeing. Availability and cost are just a few aspects of a broader food system in which the ability of a consumer to eat healthy foods is influenced by everything from federal agricultural policy to regional distribution networks and food industry marketing strategies.

During this week’s rotation with the Center for a Livable Future I had the opportunity to witness many aspects of Baltimore City’s food system. One way that consumers can interact with food producers is through Community Supported Agriculture (CSA), in which participants pay farmers directly for a weekly share of produce throughout the growing season. I helped to distribute CSA shares from One Straw Farm to JHSPH affiliates as part of CLF’s CSA project as well as to participants of the Franciscan Center’s Fresh Harvest CSA Project. The Fresh Harvest CSA is a new multi-organization collaboration that allows the Franciscan Center to provide free shares to 30 low-income participants. The weekly produce pick-ups are orchestrated very carefully so that each participant meets with a staff member to talk about successes and challenges in using the previous week’s share and receives recipe ideas for using the current week’s share. (Here’s my recent recipe contribution, for veggie spring rolls.) The lessons learned from this season’s Fresh Harvest CSA can help other CSAs to encourage fruit and vegetable consumption among a broader clientele.

This week I also experienced another way that Baltimore residents can obtain food – through the hot nutritious lunches provided on weekdays at the Franciscan Center and other charitable organizations. It was rewarding to share a community meal with almost 500 guests that was created with the nutrition and health of the population in mind. The kitchen staff at the Franciscan Center has shown a commitment to nutrition by participating in the Meatless Monday campaign and using fresh vegetables from surplus CSA shares to deliver quality meals to their guests.

While only a small portion of the population participates in CSAs or shared community meals, most of us are familiar with supermarkets. This week I also had the chance to shadow Sheryl Hoehner, a Registered Dietitian who is helping the Food Depot in reaching its goal of providing healthy foods to low-income shoppers. Helping Sheryl give demonstrations of healthy back-to-school breakfast ideas showed me that the dietitian-supermarket relationship has many advantages. Although dietitians in clinical settings can suggest strategies for reducing sodium or saturated fat intake, these recommendations are often lost somewhere between the hospital and the aisles of the grocery store. Sheryl was able to provide specific product recommendations for clients and address their concerns about cost, taste, and methods of preparation. Her presence in the store was a good reminder that our health is directly related to food and that supermarkets can indeed prioritize the health of the consumer.

My time with CLF this week allowed me to interact directly with community members as they participated in various aspects of Baltimore City’s food system. This week’s experiences strengthened my commitment to not only hone my skills in clinical dietetics so that I can best serve the patient population, but also to advocate at the population level for improvements to the food system so that fewer people require care in acute clinical settings for nutrition-related issues.

THE DIETETIC INTERN SERIES
Trying New Things: Notes from a Dietetic Intern (Part 1) – by Khrysta Baig
Food Systems and Patient Care: Notes from a Dietetic Intern (Part 2) – by Marie Spiker
Hands On in the Community: Notes from a Dietetic Intern (Part 3) – by Bernice Chu
The Nutritional Environment: Notes from a Dietetic Intern (Part 4) – by Caitlin Krekel
Small and Big Pictures: Notes from a Dietetic Intern (Part 5) – by Candice Gormley

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