Second Week as an Intern

My second week of my Public Health internship has been an educational whirlwind. Getting exposed to the nutritional needs of low income communities has been a great, albeit distressing experience. As much as I love the science of nutrition and learning about the optimal human diet, it’s really important that I get a chance to see the realities of nutrition in our country, especially for people who do not have the luxury of completely free food choice that I have.

If you haven’t had the opportunity to experience this for yourself, I highly recommend volunteering at a local hunger organization in your area. Sometimes I feel like people involved in the Ancestral Health movement can be somewhat selfish in thinking that high quality ‘Paleo’ food is the only way to eat. (I include myself in this sentiment – the amount of time I spend concerned about my own health is excessive.) I think as a community we all need to take a step back and remember that not everyone has access to the same level of food quality that we do, and think about ways that we can make good nutritious food available to more people. The health of our nation depends on it.

Anyway, enough pontificating – here’s a brief summary of my experiences this week. I wish I could go into more detail but its a bit overwhelming to try and recap everything you’re exposed to over a four day time period. Hopefully my major points are addressed.

Tuesday 5/29

My classmate and I discussed our summer project with our preceptor, which will be to develop an extra class to be used in future Cooking Matters curriculum as a second week. IFFS has been struggling somewhat to come up with supplemental educational materials that not only work in the Cooking Matters teaching format, but also promote the goals of the organization while meeting the community’s needs. My classmate and I will be doing formative research and lots of creative brainstorming to come up with different potential topics for additional educational materials. It’s challenging to work within the nationally established curriculum of Cooking Matters, as well as determining which topics are worthwhile developing materials for based on the population taking the class. It’s fun to take our skills out of the classroom and apply them to actual projects.

We also attended a Nutrition, Farms, and Gardens meeting, where we brainstormed names for a Growing Power workshop, helped with some website revamping, and discussed the budget for the summer, which is typically much lower than it is during the winter due to decreased donations. We also had a staff appreciation moment for the YFTP assistant, which was great; it shows good teamwork and team building ability on the part of the Nutrition Division at IFFS.

Wednesday 5/30

After developing interview questions for our preceptor, my classmate and I had a meeting to talk about the Mobile Markets that IFFS puts on in low income neighborhoods. The major responsibilities of mobile markets are providing food at location, with an emphasis on fresh produce, as well as developing a Food Matters curriculum to educate participants at the markets, whether that be nutrition or cooking education, or both. Each location has its own volunteers that decide how food gets distributed, and there is no application process required to come get food. These markets are intended to be an emergency food source, but some are return visitors. The  market directors often try to focus on ‘oddball produce’ to help teach how to cook seasonal vegetables available, since they can be intimidating to people who are unfamiliar with the produce.

An IFFS Mobile Market

The employee we spoke with said she hasn’t seen anyone address the ‘junk’ food that they provide, which could be an area for improvement. It’s obviously challenging for a group to provide unhealthy food to people in need, but then to tactfully explain to them that the food they are being given is not something to be eaten as a dietary staple. I’m not really sure how that would best be handled. Fortunately, the market coordinators provide recipe and healthy eating cards that get handed out to participants, and are developing surveys to help understand what people want to learn about at the market. These surveys will also determine what volunteers and market managers think the issues might be in their own communities, with the help of Mobile Market roundtables that invite market managers, volunteers, and interns to share experiences and ideas, pool resources, and perform general troubleshooting.

My classmate and I also spent some time planning for our first Cooking Matters class: deciding the recipe, discussing potential modifications, and determining what questions we needed to ask about the facility, ingredients, and the group that we’re working with. We helped our preceptor with some documentation of end-of-class surveys from a previous class, and learned about Share Our Strength’s (SOS) evaluation process. I couldn’t believe the amount of paperwork required, and all of it would be sent to the SOS head office in DC. Pretty mind boggling, and I wondered what the benefit of it all ended up being.

In the afternoon, we interviewed our RD preceptor about her role as supervisor of the Nutrition division at IFFS, as well as staffing and budgeting procedures in the nonprofit world. It seems that much of her job is staff management, which is a difficult task when the budget is limited and ideas for programming are constantly being developed. Her ultimate goals include improving the nutritional quality of recovered food, expanding nutrition education opportunities, and raising the nutrition standards of each division at the organization. She admitted that there is a constant struggle to get good food out, rather than ‘just food’, while still staying connected to the community’s needs and wants. She tries to avoid ‘mission drift’ as much as possible, and prioritize the small staff’s efforts on a few collaborative efforts to solve hunger issues in the Raleigh area. We had a great discussion with our preceptor, and we learned a lot about how nonprofit organizations function, both in the financial and the human resources department. I’m glad we’re working at a nonprofit, because it seems that these organizations need to be much more innovative to source their funding, as compared to a public health department that works on the taxpayer dime. If I had more space, I’d go into the details of our interview because it was quite informative.

Thursday 5/31

The Young Farmer Training Program

On Thursday we met with  the head instructor of the Young Farmer Training program (YFTP) to go over the Cooking Matters class that we will be teaching her students. We took a tour of the kitchen space in order to determine the type of facilities we had available; fortunately, the kitchen is well stocked with great appliances and plenty of room for recipe prep, which is great. Our preceptor reminded us all that we don’t have a lot of wiggle room in the Cooking Matters curriculum, but that we could determine a few ways to incorporate the YFTP mission into the lessons. We plan to use as much fresh produce from the farm as possible in our recipes, and will be working with the YFTP organizer to coordinate the harvest and recipe planning.

There was some level of disagreement among us – for example, the YFTP organizer wants to limit the amount of animal products we use in our recipes, but our preceptor reminded her that not all the teens share the same viewpoint on food and that meat cooking skills is an important component of the class. I obviously agreed with my preceptor, and was glad that we would be sticking to this part of the Cooking Matters curriculum. Cooking meat safely (and deliciously) is a difficult skill for many people, and I believe it’s important to teach these teens how to do so in order to maximize their future nutrition. I get worried sometimes that well-meaning vegetarians are the ones teaching public health messages, and telling these kids that animal foods are less healthy is not something I want spread around to people at high nutritional risk!

High Point architecture

Friday 6/1

My classmate and I made our first trip out to Guilford County this week, ending up in High Point to meet with the RD at the local WIC clinic. It was interesting to see the socioeconomic dynamics of this area, and the city itself was somewhat of a strange place with a huge amount of modern furniture warehouses that were quite architecturally attractive, and yet the streets were utterly deserted. Additionally, traveling just minutes outside the city limits, we saw that most of the housing was run down, boarded up, and not an appealing place to live at all. It was a bizarre juxtaposition, and we were interested to hear about the history of the area.

The 'real' High Point

Meaningful Event

Meeting with the RD at the WIC clinic in High Point was an eye-opening experience to say the least. I had never been to a WIC clinic before, and had no idea what to expect from the experience. The RD was amazing; she was completely forthcoming about every topic we discussed, and was thorough in answering our questions about her job, the community itself, and the struggles they face in delivering services to low income mothers in the area. I learned a lot about the red tape that government health workers come up against, and about the restrictions on food that the women are under depending on their circumstances. She explained that many of the WIC procedures get missed because of the time restrictions on each visit; I don’t think any client was in the office for longer than five minutes.

The RD believes that some of the major issues in the community include poor transportation access, low levels of education, and misinformation given by other health professionals. I was appalled to hear that many doctors in the area tell mothers of infants younger than 6 months to put cereal in their baby’s formula to help them sleep. Even more disturbing is that doctors will often prescribe Pediasure to children, simply because the children’s parents continue to ask for it. It’s hard to believe a doctor could be so clueless, but now I understand why mothers are so confused about how to properly feed a child. Unfortunately due to time and budget restrictions, the RD has little opportunity to educate mothers on proper nutrition, and most educational materials are not very helpful to these mothers who may be low literacy or possibly just disinterested in reading the handouts available. We had one mother come in with a clinically obese 4-year-old (who did not look obese at all), who seemed interested in what the RD had to say but made a lot of excuses for why her daughter was eating too much. The RD decided not to use the word “obese” but rather point out that the girl had gained far too much weight in the past 6 months and needed to have a dietary change to curb that weight gain. The mother seemed to be aware that change was necessary, but I got the feeling that she would not be making any significant changes to her daughter’s eating habits despite the RD’s helpful recommendations.

One thing is certain: I would never be able to work in a WIC clinic. The amount of time dedicated to each client is woefully inadequate, and the mothers are simply passed through the system as quickly as possible in order to get their WIC vouchers. The kind of food provided to these women doesn’t really make any sense to me. For example, a woman or child can be diagnosed with low iron, and yet no changes are made to their dietary allowances – they are simply given a handout on iron rich foods, many of which are not even accessible to them on their budgets, since meat is not included for most women on WIC.

A month of food on WIC

Women are allotted two dozen eggs per month, and once a child turns two, they no longer are allowed to purchase whole milk products and are restricted to low-fat or skim. These are two guidelines in particular that really anger me. Eggs are an incredibly nutritious food and a great source of choline, which is a nutrient critical to fetal development and brain growth in children. Dairy fat is constantly demonized by conventional nutrition authorities, despite the higher levels of fat soluble vitamins contained in dairy fat (even conventional dairy). I really hope one day these guidelines are modified to provide real nourishment to mothers and babies, but I really don’t see that happening any time soon. I’m so glad I’ll have the freedom in the future to make my own recommendations, because I could never consciously make these recommendations to people without feeling like I’m causing them harm.

I also don’t think I could handle seeing so many high-risk clients and feeling so powerless to change their situation. I was impressed by the RD’s ability to express genuine concern for the women while not getting emotionally involved in their stories, which is a talent that I believe is essential for a WIC dietitian. I hope that in my future as a practicing RD, I will be able to provide information to mothers that can help them optimize their nutrition for them and their babies, even if they are on WIC vouchers or food stamps. I also hope that one day WIC benefit standards will be adjusted in order to provide food with better nutritional quality to these women, though that seems to be a tall order.

I definitely feel this experience has motivated me to become more involved in maternal and child health issues in the future, since I believe it is the most important time for nutritional adequacy in the human lifespan, and may be the most critical time to change a person’s health. Perhaps I’ll be able to focus my efforts on this age group in my future career. I know my mom (who is also a dietitian) wants to write a book for lower literacy women on prenatal and child nutrition, and she’d like me to help. I can definitely see a huge need for such a resource, so I hope that we both have time in the future to develop something like this! (I do have lots of book ideas, just no time to write anything substantial!)

"Classy" - A WIC nutrition class from the 1960s

  • http://www.figandflower.com Katherine

    Hi Laura, I think the issue of food security/poverty/elitism is SO important to talk about and I really like the way you discussed it in this post. I volunteer in the kitchen at a day center for homeless women and while I’m not always thrilled about the quality of some of the donations they receive, the center works with what it gets, and at least this way the women get a meal, rather than going hungry. (They also have a manager works hard to provide healthy meals as much as possible, which is great). Paleo can be very elitist in what types of issues to worry about (avoiding vegetable oils, getting grass-fed versus grain-fed beef) and it not only isolates the movement from much of the country but it is a turn-off for those who work with people who cannot afford to care about those particular issues. Paleo needs to get macro, stat.

    • Sara

      I think Robb Wolf has the right message–do the best you can, because it’s 99.99999…% likely that it’s better than SAD.

      http://robbwolf.com/2011/09/21/paleo-is-expensive/

      Part of the problem, I think, is that we seem to be completely out of touch with food. So few people understand where food comes from and how to prepare it, so we start to rely on marketing without considering that food packaging is run by business, which doesn’t care about your health, only your money. Education is so important in fixing our “eating disorder” (as Michael Pollan puts it), and I think if we get our foot in the door policy-wise and at the community level we can do a lot of good for relatively little effort (ie. CHANGE policy and behaviour, rather than just fighting it from outside).