“Telling the story of self, us and now”: Seeing Environmental Nutrition in Health Care in New Ways | Nourish Wasan Retreat | October 2018

The overlap of health care and food systems is multifaceted. Nourish convened 22 leaders from across healthcare, government, food systems and philanthropy together for a four day retreat on Wasan Island in order to explore the opportunities around environmental nutrition in health care. Environmental nutrition (2014), a concept coined by Health Care Without Harm, reframes healthy food as contributing beyond individual well-being towards a collective social responsibility for creating healthy communities and a sustainable food system.

Nourish Montreal Events (Sept 5 & 6)

Nourish is hosting two events on September 5th and 6th in Montreal addressing food and health care through inspiring examples from Canada, the US, and Denmark. Please find the details below.


Event #1

Local and organic food in public institutions – Inspiration from Danish and American models

Wednesday, September 5, 8:30am

Local and organic food in public institutions event

On September 5, 2018 at 8:30 am, the Centre for Sustainable Development, in collaboration with Équiterre and Nourish, will be hosting a breakfast conference titled 'Local and organic food in public institutions – Inspiration from Danish and American models.'

Local and organic food procurement is the norm among hospitals, schools, and daycares in Copenhagen (Denmark), and in the United States.

Join us to hear about how these public institutions managed the transition and what their principal success factors were.

Through brief presentations, we will also discuss current food procurement practices in Quebec’s public institutions and what levers are necessary in order to make a similar transition.

 

MODERATOR

Colleen Thorpe, Director of Educational Programs, Équiterre
 

Panelists

  • Beth Hunter, Director of Nourish, McConnell Foundation (bilingual presentation)
     
  • Dr. Jens Kondrup, Retired Senior Physician in Clinical Nutrition, Cophenhagen Hospital Corporation Denmark (English presentation)
     
  • Skip Skivington, Vice President of Healthcare Continuity and Support Services, Kaiser Permanente (English presentation)
     
  • Murielle Vrins, Program Manager, Institutional Projects, Équiterre (French presentation)

 

Event #2

Local and organic food in public institutions – Inspiration from Danish and American models

Thursday, September 6, 12:00pm – 1:30pm

Connecting Food & Health Care Montreal Event

Join us to hear inspiring stories of transformative change towards nourishing and sustainable food in hospitals.

The event will take place at CHU Ste. Justine3175 Chemin de la Côte-Sainte-Catherine, Montréal. Please meet at room A918 to be directed to the meeting room. Questions? Contact Sophie Tremblay at 514-345-4931, ext. 4609

Presentations will be followed by a moderated discussion. A light lunch will be served, compliments of the CHU Sainte Justine food services, featuring local organic food.

Introduction and facilitation by Beth Hunter & Hayley Lapalme (Nourish / McConnell Foundation)
 

Presenters

Josée Lavoie (French presentation)
Manager of Food services at CHU Sainte-Justine. Josée Lavoie is a dietician and director of food services at the CHU Sainte-Justine in Montreal, leading their prize-winning transformation to room service as well as initiatives to increase the local and organic food served.

Dr. Jens Kondrup (English presentation)
Retired Senior Physician and Head of Clinical Nutrition, Copenhagen Hospital Corporation, University of Copenhagen, Denmark. Dr. Kondrup was the founder and long-time chairman of the Danish Society of Clinical Nutrition and was an active participant in the Cophenhagen House of Food, which increased procurement of organic food from 40 to 90% in the space of a few years.

Skip Skivington (English presentation)
Vice President, Healthcare Continuity and Support Services, Kaiser Permanente, United States. Kaiser Permanente is a US healthcare provider for over 13 million people. Skip Skivington has overseen much of Kaiser Permanente’s innovative work on sustainable and healthy food in hospitals, including a pledge to buy all of its food locally or from farms and producers that use sustainable practices and use antibiotics responsibly by 2025.

Click here to see complete presenter biographies.

[Nourish Event] Food on the Public Plate: Lessons from Canada, US & Denmark

Nourish invites you to an afternoon of presentations and discussions with local and international guests who will be sharing their inspiring stories of transformative change towards sustainable food in hospitals and other healthcare facilities in Canada, Denmark and United States.

Two Nourish events will be hosted in Toronto on September 10, 2018 - this event and a lunchtime event at St Micheal’s Hospital.

Presentations will be followed by a moderated discussion and Q&A. Light refreshments will be served.

Click here to register and learn more about this event.

Partners: Food Secure Canada, MaRS Discovery District, St. Michael's Hospital, OpenLab, The Canadian Coalition for Green Health Care

MaRSDD Event Poster

[Nourish Event] Connecting Food & Health Care: Lessons from Canada, US & Denmark

Nourish invites you to a lunch hour of presentations and discussions with local and international guests who will be sharing their inspiring stories of transformative change towards addressing malnutrition and sustainable food in hospitals and other healthcare facilities in Canada, Denmark and United States.

Two Nourish events will be hosted in Toronto on September 10, 2018 - this event and a second event later in the afternoon at MaRS Discovery District.

Presentations will be followed by a moderated discussion and Q&A. This is a bring-your-own-lunch event. Light refreshments will be served.

Click here to register and learn more about the event.

Partners: Food Secure Canada, MaRS Discovery District, St. Michael's Hospital, OpenLab, The Canadian Coalition for Green Health Care

St. Mike's Event Poster

Nourish Day at Grove Park Home

  In the front section of the resident garden. From left to right: Travis Durham, Wendy’s colleague/neighbour, Wendy Smith, Peter Dickey (Owner, Beekeeper– Dickey Bee Honey), Chris Wong (Partner– The Growing Connection), Sandra Wolf (Manager of Environmental Services– Grove Park Home), Hayley Lapalme, Cheryl Hsu, Robert Patterson (Founder– The Growing Connection), Vidhi Gupta

In the front section of the resident garden. From left to right: Travis Durham, Wendy’s colleague/neighbour, Wendy Smith, Peter Dickey (Owner, Beekeeper– Dickey Bee Honey), Chris Wong (Partner– The Growing Connection), Sandra Wolf (Manager of Environmental Services– Grove Park Home), Hayley Lapalme, Cheryl Hsu, Robert Patterson (Founder– The Growing Connection), Vidhi Gupta

On an overcast July morning, the Nourish Toronto team drove from Toronto to Barrie to visit Grove Park Home, second home to our Nourish innovator– Travis Durham, a place where community and care come together to serve nearly 140 elderly residents. In May, the long-term care facility celebrated its 50th anniversary, and last month Travis’ Nourish work made it to the national news on CTV.

We made several stops on this tour, which was filled with activities, delicious local treats and engaging conversations with both staff and residents; the highpoints being the time we spent in the on-site resident garden and at the backyard beehive with the residents, Ila and Robert.

The resident food garden, an open, green courtyard in the centre of the complex has nearly two dozen raised planters and is a great example of accessible, spatial design. Seeing the garden, it is hard to imagine that this space had been unused and closed off to residents for fifteen years due to mobility hazards. Now it’s a favourite area for residents, guests, and staff. In front of us was a garden in full bloom, with rows of corn, tomatoes, ground cherries, basil, zucchini, sweet peppers, beets, rosemary and lettuce– all tended by residents.

For this project, Travis partnered with Robert Patterson, a farmer, whose organization– The Growing Connection specializes in innovative horticultural systems. At Grove Home, he worked with Travis to set up the food garden, starting with a dozen Caja boxes, and last fall the resident council co-chaired by by Ila Ellison, purchased an additional two dozen boxes to scale up the initiative.

 
  Left section of the garden with the tall corn stalks and rows of vegetables and herbs

Left section of the garden with the tall corn stalks and rows of vegetables and herbs

 

Robert has brought his Caja boxes all over the world, working with communities in the North and internationally. “When the grandmothers have taken on the change, that’s when you know it is sticking. Here at Grove Park, we start with the grandmothers,” said Robert as he walked us through the motivations, mechanics and benefits of the garden program.

The garden (also a part of the facility’s DementiAbility program) has notably enriched the lives of the residents by creating an accessible on-site green space wherein they can connect with their surroundings and each other, and also get the freshest produce on their plates. Last year, it won the AdvantAGE Ontario Innovation Award for Seniors’ Life Enrichment.

When the grandmothers have taken on the change, that’s when you know it is sticking. Here at Grove Park, we start with the grandmothers
— Robert Patterson, Founder, The Growing Connection
 
  Resident council Ila Ellison with beekeeper Peter Dickey examining a slab from the beehive

Resident council Ila Ellison with beekeeper Peter Dickey examining a slab from the beehive

 

Later in the afternoon, we got to tour the backyard beehive with beekeeper, Peter Dickey of Dickey Bee Honey. The Grove Park bee program was started last year with the goal to have resident-supported, on-site honey production. Since then, the residents bankrolled a private-label honey program through which they have sold over 350 jars of honey, bringing in profits that have already exceeded the target set for 2019. The abundance of honey harvested has also led to a shift in the residents’ food habits to the extent that honey has replaced fruit jams on toast, and is now a permanent breakfast condiment.

Along with the support that Travis and the senior leadership team have lent to the project, the success of both the garden and beehive is underpinned by the involvement of the residents in the planning, management and maintenance of these projects. These ground-level breakthroughs at Grove Park Home are a great example of how engagement of senior leadership, resident-focused decision making and community partnerships can be leveraged to improve the quality of care, and consequently the quality of patient life in health care.

Webinar: Reframing healthy food in health care

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The question of what qualifies as “healthy” food is highly contested in health care and beyond.
This conversation is alive and well in our leadership cohort, and we want to engage it publicly.

This webinar will bring together four varying perspectives from four thought-leaders to explore how hospitals and health care facilities can lead the charge in expanding the definition of healthy food, to better serve people, patients, and the planet.

Join panelists: Kelly Gordon, R.D Six Nations Health Services; Diane Imrie, Director of Nutrition at the University of Vermont Medical Centre; chef Joshna Maharaj, Take Back the Tray; and Dr Janice Sorensen, Langara College; to explore ways to better connect food and health through the patient meal experience, food service operations, food environments, and making connections from health care settings into community.

The four speakers bring powerful insights from the frontlines of the Healthy Food in Health Care movement in the US; a community strengthening connection to traditional foods and foodways as a pathway to well-being; innovative clinical research underway in Canada and Denmark; and multiple institutional food overhauls around the Greater Toronto Area.

Come with questions and take away a more nuanced understanding of how food can support health and healing, and how to take next steps to advance this conversation in your own organization.

Tweet your questions for the panelists and cohort to @NourishLead -- and please forward this invitation widely.

Register in advance for this webinar: 
https://zoom.us/webinar/register/WN_tAWMOBE6QHud2g8Li31yCA

After registering, you will receive a confirmation email containing information about joining the webinar.

 

Panelists:

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Kelly Gordon is a Registered Dietitian and Kanyen’keha (Mohawk), bear clan and a proud mother of two energetic children. She works for Six Nations Health Services as a Community Dietitian; she previously worked for Toronto Public Health and Davenport Perth Community Health Centre.

 
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Diane Imrie is the Director of Nutrition at the University of Vermont Medical Centre (UVM) and is a registered dietitian. UVM was one of the first hospitals to sign the Healthy Food for Health Care pledge in 2006.  Diane is actively exploring the gap in understanding about how healthy food is impacting the environment.

 
  Joshna Maharaj  is a chef and activist who has worked in three different institutional contexts: Sick Kids Hospital, Scarborough General Hospital and Ryerson University. She is an advocate of the role institutions can play in food systems and is passionate about fresh, wholesome and seasonal foods.

Joshna Maharaj is a chef and activist who has worked in three different institutional contexts: Sick Kids Hospital, Scarborough General Hospital and Ryerson University. She is an advocate of the role institutions can play in food systems and is passionate about fresh, wholesome and seasonal foods.

 
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Dr. Janice Sorensen is a registered dietitian and a researcher with a PhD in Clinical Nutrition. Currently, Janice is teaching at the Nutrition & Food Service Management program at Langara College in Vancouver and co-chair of the Food in Healthcare Working Group of the Canadian Malnutrition Task Force

Summer 2018 Newsletter: What is Healthy Food in Healthcare?

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What is healthy food in healthcare?

The question of what qualifies as “healthy” food is highly contested in healthcare and beyond. In June, we brought together the varying perspectives of dieticians and chefs for a rich discussion with Nourish innovators around how hospitals can lead the charge in expanding the definition of how food is produced, prepared and consumed for patient, population, and planetary health. We wanted to share the highlights below.

Do want to be part of this ongoing conversation around healthy food in health care? Nourish is hosting a public webinar on Aug 23, 2018 12:00 PM EST to explore broadening our understanding of healthy food in the health care setting in late August 2018. Please RSVP

Food is the way we receive nutrients from the earth
— Joshna Maharaj, Chef and Activist
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Joshna Maharaj, Chef & Activist
A farmer friend told me: “food is the way we receive nutrients from the earth.” To remember that the earth is full of nutrients and food is its natural delivery mechanism has changed my entire approach to endorsing how people eat as a chef. My take on healthy food is to move away from word “healthy”, which makes people think about a wagging finger and sacrificing their pleasure when it comes to eating. We need to redefine and broaden the metrics that we use in assessing our food. Good food should be healthy for everyone involved, including those who grew and cooked it, and how much travelling did it take to get the food to the plate?
 

Food is integral to population health management and the future of health care.
— Diane Imrie, Director of Nutrition Services, University of Vermont Medical Center
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Diane Imrie, Director of Nutrition Services, University of Vermont Medical Center
At the University of Vermont Medical Centre, we believe that food is integral to population health management and the future of healthcare. We consider the impact of food on patient health, employee health, as well as community health, climate health and agricultural health. Our goal is to weave food through all the things we offer as an organization and to tie it to our mission to support the health of our population. We set a food plan with priorities every year and we stick to it.

Food is only healthy when it’s eaten.
— Dr. Janice Sorenson, Dietitian and researcher with Canadian Malnutrition Task Force
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Janice Sorenson, Instructor of Nutrition & Food Service Management at Langara College
There is a difference between healthy eating for healthy populations, which prevents the risk of diet-related and chronic diseases, and eating for health, which is part of the treatment for vulnerable patients to heal. We have to remember that food is only healthy when it’s eaten. From the patient’s perspective, there are different factors that motivate their eating, from their pleasure and comfort, to ease and what feels satiating to them. As care providers, working with malnourished patients is encouraging them to eat energy and protein dense foods, which sometimes might be seen as junk food.


How do you choose where to start with food? Especially in finding the complementarities between short term and long term patient needs?

Janice: We need to make the case that hospital food is an essential part of care and not an operational cost. The impact of short-term care can have long-term implications that will lead to cost-savings in a clinical context. When I moved to Denmark in 2003, , it was exciting because when they adopted the Council of Europe Resolution on food and nutrition care in hospitals to position the nutrition care in hospitals as a fundamental human right. The policy resolution was instrumental in arguing for adequate resources to help elevate food as an important part of treatment and care in hospitals. Suddenly, hospitals were hiring chefs and winning food service awards. This work can be a difficult process and takes time, but through advocacy and policy, it can happen.

Joshna: It’s important to remember the change doesn’t happen in one step and that there are multiple points of entry. It’s about finding the low-hanging fruit to put better food on the patient plate -- if we can’t go organic now, then we’ll get started by working with co-op farmers. Ultimately, we need to find ways to break it down into smaller steps and priorities. The important piece is that everybody’s feet are still pointed in the same direction and their values guide the process.

We need to make the case that hospital food is an essential part of care and not an operational cost.
— Janice Sorenson
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How do we balance the tension between empowering patient food choice and an “expert” approach to prescribing what is healthy?

Diane: We have a very liberal approach to diets and moved to room service in 2006, which put patients in the driver’s seat and led to 20% waste reduction. However, diet liberalization does not always get backed up by what qualifies as “expert” research -- for example, we want to be more liberal on cardiac diets, but the recommendations from heart associations may not back our desire to loosen our guidelines.

Janice: It’s fantastic to hear that hospitals are prioritizing choice and liberalizing diets. In fact, there is evidence to show that individuals on restrictive therapeutic diets are actually more at risk of malnutrition. TThe importance of diet liberalization is that patients can be offered appetizing foods that they actually want to eat in sufficient quantities to avoid malnutrition in hospital. In an acute care setting, food choice should trump dietary guidelines for health promotion around heart health.

 

How do we promote and enable more sustainable food purchasing in hospitals?

Joshna: Talking about sustainability in healthcare can be challenging, where you fight against the charges that sustainable food is a luxury that we cannot afford. However, a small example of a megawin was when I discovered organic oats ordered from a local mill were just pennies different from Quaker oats offered by Sysco. In fact, when we starting purchasing the organic oats, we heard from the food production team that the oats were too dense for the patients. So we went back to the mill and told them about our problem, and they ran the oats through the mill again for a finer grain! It’s important to recognize how the beauty of human connection enabled this transaction, which might not have been possible with a larger distributor and supplier.

Diane: You can’t move ahead until you ask where you can find added value and pull it out of the system. Healthcare institutions have reputational credibility and are well resourced enough to pay ahead or offer loans. For example, we wanted to source organic chicken from a farm but we reached a point where we could not arrive at a price point that mutually worked. However, we discovered that the farm was cash solid in late fall but cash poor in the spring when they buy their chicks. Having money on hand in the spring can enable them to buy chicks at a lower cost. So we loaned them $35,000 in the spring for a 2-3 % price reduction and they paid us back in the late fall. Being creative about your supply chain is essential --  what can you offer to your supplier to help bring down the costs and bring value to that relationship?

 

What are your thoughts about hospitals taking a stand around purchasing organic foods or antibiotic-free meat?

I have no qualms saying organics are our priority now.
— Diane Imrie

Diane: There have been articles going around about the rise of antibiotic resistance in the hospitals across the country with evidence about the huge expenses and terrible outcomes for patients. On the organic front, we don’t need more evidence that organics are better for human health other than the fact that that pesticides are bad for the health of farm workers handling it. I have no qualms saying organics are our priority now.

Joshna: Organic comes up a lot and I pushed the agenda for organic milk for kids specifically. We worked with local economy dairy and found opportunities through economies of scale. When you have a collective priority, one thing can evolve into the other. I care about local sourcing, but I saw like Diane that once you get into local, you see farmers growing organically. The costs could legitimately come down.

 

Recognition is growing about the need to serve culturally-safe food to Indigenous peoples in care. A number of our cohort members serve significant populations of  Indigenous patients and residents, and most Canadian health care organizations serve some Indigenous populations, whether rural or remote. Where is your thinking about how traditional foods fit into this healthy food conversation?

Janice: This is still an area of learning for me. But I see it strongly relates to the idea that food is only healthy if it’s eaten, and we already understand the importance of serving culturally-sensitive food.

Joshna: I learned an interesting lesson when I was visiting Sioux Lookout and discovered that they have a country food menu for their Indigenous population. They were able to bring food in that is hunted and harvested, and provide traditional recipes for the staff about how to prep and serve these foods. This is a great indicator that we can serve our Indigenous populations and bring thoughtful lessons on how to apply this to the rest of the patient population.

 

What are some of your last thoughts on the critical areas that we need to focus our attention on?

Janice: Remember that food is only healthy if it is eaten. Addressing malnutrition is a part of the pathway to seeing food as an important part of healthcare.

Joshna: We won’t be able to see the evidence about the role of food in healing using the traditional metrics. We need to be open to broadening our metrics around nourishing food to be more inclusive of the wider food system.

Diane: Don’t underestimate the importance of embracing the culture of food in organizations, even if it takes a long time to change. As innovators, keep working on being role models so that policy makers have something to embrace when change happens.

We need to be open to broadening our metrics around nourishing food to be more inclusive of the wider food system.
— Joshna Maharaj

Joshna Maharaj is a chef and activist who has worked in three different institutional contexts: Sick Kids Hospital, Scarborough General Hospital and Ryerson University. She is an advocate of the role institutions can play in food systems and is passionate about fresh, wholesome and seasonal foods.

Dr. Janice Sorensen is a registered dietitian and a researcher with a PhD in Clinical Nutrition. Currently, Janice is teaching at the Nutrition & Food Service Management program at Langara College in Vancouver and co-chair of the Food in Healthcare Working Group of the Canadian Malnutrition Task Force

Diane Imrie is the Director of Nutrition at the University of Vermont Medical Centre (UVM) and is a registered dietitian. UVM was one of the first hospitals to sign the Healthy Food for Health Care pledge in 2006.  Diane is actively exploring the gap in understanding about how healthy food is impacting the environment.

Addressing the staggering prevalence of malnutrition in Canadian hospitals

By Cheryl Hsu, Writer, Nourish Health

 

Dr. Karen Cross has a bustling Plastic and Reconstructive Surgery practice at St. Michael’s Hospital in Toronto, where she specializes in complex tissue healing.  Her patients come to her when their wounds won’t heal; some are diabetics with chronic foot wounds, while others have traumatic injuries or are having a hard time recovering from past surgeries.

For the most part, Dr. Cross has a “healthier” patient population than the hospital at-large since the surgeries she performs are elective and the patients are given the time to assess the potential risks and benefits, Despite that fact, some of the  patients she was seeing had open wounds for months (or even years) when they come to her for the first time. She suspected that those non-healing wounds were a sign of a deeper problem: malnutrition.

Dr. Cross and her research team led by Dr. Julie Perry set out to screen all the patients in her clinic for risk of malnutrition using a questionnaire developed and tested by the Canadian Malnutrition Task Force (CMTF). The results were astounding:  one in four of Dr. Cross’ patients were found to be at risk for malnutrition, and one in two diabetics with foot wounds were at nutritional risk. They concluded that it is vital to identify malnourished patients prior to surgery because malnutrition can cause significant complications after the surgery and with non-healing wounds.

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Seeing and understanding malnutrition

Nutrition needs to be seen as a vital part of health, and screening for it a non-issue. Like blood pressure measurement, assessing malnutrition should be automatic; you know what to do and there is a system of care in place to respond.
— Dr. Heather Keller, Chair, Canadian Malnutrition Task Force

We know that proper nutrition and eating healthy food promotes health, supports organ function, and is vital to healing. However, nutritional status is not consistently assessed among patients entering the Canadian hospital system. This is in spite of the fact that malnutrition is predictive of medical and surgical complications and other negative health outcomes, to the extent that the 30-day mortality rates of malnourished patients are more than 6 times than those of patients with good nutritional status. A national study conducted by the Canadian Malnutrition Task Force has revealed 20-45 per cent of patients admitted are malnourished. The same study found that there are significantly higher in-hospital costs for malnourished patients, due to greater lengths of stay and readmission rates. If this is the case, why are we not seeing malnutrition as a national health crisis that needs to be addressed?

Some of this comes from the public misconceptions about malnourishment and what it looks like. People who are malnourished may not self-identify as such; for example, being overweight or obese is also a form of malnourishment. Malnutrition is when the body does not get the right amount -- whether is a deficiency or excess -- of the vitamins and nutrients it needs to maintain healthy tissues and organ function. A lot of people see malnutrition as something that is more prevalent in developing countries, or more relevant to children and elder care rather than adult care.

 

Minimum screening for malnutrition in Canadian hospitals

“We showed the hospital that it’s really simple, it doesn’t add anything that delays the admission process; but what this does is allow you to save yourself on the cost of hospital stays and complications down the road.”
— Bridget Davidson, Director, Canadian Malnutrition Task Force

The exciting thing is that Canada is currently leading evidence-based research around addressing malnutrition in acute care settings. The Canadian Malnutrition Task Force is developing solutions that promote early identification of nutrition challenges for patients in hospitals and proposing actions to address the problem. Focussing on interventions in acute care is a powerful nutrition care pathway because it drives most of the costs of the Canadian health care system.

The CMTF has developed and tested a quick and simple tool to screen for malnutrition when a patient is admitted into the hospital. The Canadian Nutritional Screening Tool consists of two questions: (1) have you lost weight in the past 6 months without trying to? (2) Have you been eating less than usual for a week?; where 2 “yes” answers indicate nutritional risk. This screening tool is an intervention that can be implemented at no additional cost, but it does beg the question of how the healthcare system can -- and should -- respond.

One of the biggest barriers to addressing malnutrition is uncertainty around the capacity of hospitals to provide a pathway of care for the patients who are flagged at risk. However, simple interventions like making sure that patient meal times are protected and working with food services to offer comforting, appealing and culturally appropriate foods are ways to ensure that patients are not leaving their food uneaten. In the UK, there are protocols where at-risk patients are provided with red trays as a visual indicator to prompt dieticians and nurses to help those patients read menus, choose healthy foods, and receive physical support to eat. These opportunities see the hospital as a critical intervention site to educate a captive audience of patients about nourishing eating and lifestyle practices before they enter back into the community.

More recently, the Canadian Malnutrition Task Force began testing and implementing a ‘nutritional care pathway’ in ten hospitals to evaluate its impact. Where their first study was focussed around identifying the impact and prevalence of malnutrition, the second study looks at the practical, actionable solutions that hospitals can take on.

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Malnutrition forces us to look at the role of the community

We know that food is medicine, yet we do not prescribe healthy food nor is it covered under health insurance. We need to establish that food plays a key role in the systemic health of patients.
— Dr. Karen Cross

Addressing the root causes of malnutrition cannot be limited within  hospital walls. The next step is to link up with whole-of-community approaches to understanding how malnutrition is linked to other social determinants of health – including food insecurity, lack of education, poor housing and poverty.

However, the power and value of starting with screening for malnutrition in hospitals is that the health care sector can no longer ignore malnutrition as a hypothetical problem. There are now black and white numbers indicating that up to 45% of patients come in malnourished. There is mounting evidence about the negative health outcomes of malnutrition and financial costs of increased length of hospital stay and readmission rates in dollars and cents. A data-driven argument can be made to policy and decision-makers that investing in the role of food in health care, from increasing nutritional support in the hospital to enhancing food service, can lead to significant health care savings and better health outcomes in the long run.

How can dietitians learn from Indigenous food ways?

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Kelly Gordon is a Nourish innovator and is a Registered Dietitian currently working with the Six Nations of the Grand River. Kelly is Kanyen’keha (Mohawk), bear clan and a proud mother of two energetic children. Her current focus is working to integrate Traditional knowledge into her everyday practice, supporting community members on their journey towards wellness.

 

As health care providers, we need to address the social, emotional, mental and spiritual dimensions of the relationship that people have with food.

When most dietitians advocate for the role of food in health and healing, we emphasize the physical and nutritional impact it has on our bodies. However, as health care providers, we need to address the social, emotional, mental and spiritual dimensions of the relationship that people have with food.

I have been working as a registered dietitian for 15 years and as an regulated health provider, I choose to weave these dimensions into my dietetic practice. At Six Nations Health Services, I work to improve the community members’ relationships with food. When people are instructed that they need to choose ‘healthier fats’ or have to ‘eat smaller carbohydrate portions’, it can be irrelevant when they may present as food insecure or have been impacted by trauma. For me, it is about listening to and understanding them so that I can draw from their experiences to expand their relationship with food. This can be the starting point to highlight the kind of positive behaviour change that can co-exist with their needs.

My personal journey developed during my bachelors of science from the Nutrition and Dietetics program at McGill University. I ended up doing a work study placement at the Centre for Indigenous Nutrition and Environment (CINE) where they connected me with other Indigenous dietitians. My university years were deeply formative to me in connecting more deeply with my own Mohawk roots and learning about the importance of food in community health. However, the impacts of community health and food insecurity are not discussed enough at school. We didn’t talk about the environmental impact of how food is grown, or the relationship between food and land. This may be the reason why dietitians are prone to work in more clinical settings instead of working in community health, because we’re trained to see ourselves most fitting into a clinical environment.

With dietitians, this leads to an underlying expectation around the judgemental responses people anticipate us to give. I’m often sitting around people who exclaim “don’t look at what I’m eating, it’s not good!” when they find out I’m a dietitian. When people say things like that, I think about what their connection is with their food that triggers this fear of judgement. I also consider the kind of food and healthcare culture we have that reinforces this shame and stigma when it comes to what we eat.

As dietitians, we need to learn that we’re not just here to fix a ‘problem’. This is a colonial mindset in healthcare that is challenging to overcome. Our mandate to provide safe and reliable health information is inherently biased around a particular set of criteria that determines what is evidence-based and quantifiable. Why do we overlook Indigenous wisdom derived from generations of community-based and historical knowledge?

A lot of my learning comes from my interactions with the Six Nations community and following the direction and voices of Indigenous community members. As a dietitian, I don’t come in claiming to be an expert, but as a person who will listen, learn and support.

We need to learn how to shift the current perception around the dietitian’s role, and the role of the health care provider overall. This means moving away from dominant western biomedical care practices and establishing a model of care rooted within Indigenous practices and food ways.  It is crediting Indigenous wisdom as reliable and trustworthy information. A lot of my learning comes from my interactions with the Six Nations community and following the direction and voices of Indigenous community members. As a dietitian, I don’t come in claiming to be an expert, but as a person who will listen, learn and support.

We need to learn that even the term “healthy food” should be challenged. The idea of “healthy” foods has become limiting and is causing shame around what people should or should not eat. There is a role for Indigenous knowledge to inform a more holistic understanding around what is nourishing food, and to enable us to re-examine people’s emotional, cultural and spiritual connections to food, as well as food’s connection to land and the greater environment.

The way that we eat is a massive contributor to the environment beyond our physical selves. If we look at the ways that our ancestors have nourished their whole selves by eating the foods that grew in their local regions, and by eating in amounts that allow all to eat, we find practices embedded in the Seventh Generation teachings. How we eat and practice in our daily lives should be mindful of what the world should look like seven generations from now. Our teaching around food and foodways shifts us to being more mindful about the good energy we pour into how we obtain and prepare our foods, and to being thankful for our food and who prepared it. This allows us to cultivate a more meaningful and mindful relationship with food that nourishes our bodies, minds and spirits.

Self-awareness and understanding has to go hand-in-hand with the actions taken for true reconciliation to happen.

This kind of mindful work takes a lot of time and effort and it can’t be done quickly. Right now, I’m working with a team of dietitians and food service professionals from across the country on a project where we want health care organizations to acknowledge and provide Indigenous and Country foods. However, choosing to source and serve Indigenous foods cannot just be a checkbox. It needs to be about stepping back and gaining more self-awareness around why it is so valuable and important to include traditional foods and food ways. Self-awareness and understanding has to go hand-in-hand with the actions taken for true reconciliation to happen.

  Myself and fellow Nourish innovator Shelly Crack at the Reconciliation Totem Pole in British Columbia.

Myself and fellow Nourish innovator Shelly Crack at the Reconciliation Totem Pole in British Columbia.

Recently, I presented at the Dieticians of Canada conference in Vancouver and visited the Reconciliation Totem Pole at the University of British Columbia with fellow Nourish Innovator Shelly Crack. This beautiful structure created by a Haida artist symbolizes a violent and brutal break in Indigenous culture with residential schools. This made me reflect on how like a bone, when culture is broken, it may never function the same way. However, the more important question is the one around healing -- when something breaks, what kind of physical, emotional and spiritual rehabilitation is required to nourish and build up strength again? I believe that food is a great way to nourish, but it is also a critical part of starting and continuing these kinds of difficult conversations.

We need more nutrition education in medical schools

By Dr. Margaret Rundle

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Dr Margaret Rundle is a Family Physician practicing at Malvern Medical in Scarborough. She completed her BSc in Nutritional Sciences, (UofT’85), Undergraduate in Medicine (UofT’89), followed by Family Practice Residency(UofT’91). Dr. Rundle founded the Rundle-Lister Lectureship in Transformative Nutritional Medical Education, which is a part of the Food as Medicine series at the University of Toronto. She, her husband and two boys, ages 27&24, enjoy very active, healthy lives.

 

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As physicians, we share a basic understanding about diet, but food remains under-appreciated as an intervention point to empower patients about the treatment and prevention of disease.

There is little dispute among care providers that a person’s dietary habits influence preventative and treatment outcomes. Every year, there is more cutting edge research validating the role of food and therapeutic diets for chronic disease management and prevention. However, basic education on the role of nutrition and lifestyle has been a blind spot in the Canadian medical school system for a long time.

I have spent the past 27 years as a Family Physician, and I make it part of my clinical work to motivate and educate my patients around the role of nutrition in their health and well-being. My interest stems from my early school years when I participated in a variety of athletics and wanted good nutrition to support my involvement.  I completed a four-year undergraduate degree in Nutritional Sciences with the intention to go into Medicine afterwards. In my four years of medical school, I was surprised to find that we were exposed to only about 20 hours of nutrition education. I recall it being primarily about knowing what are vitamins, minerals, carbs, fats, with nothing about the role of dietary interventions.

When I first started practice, I still cared a lot about the role of physical activity and nutrition but it was easy to get caught up in the day-to-day handling acute problems, making diagnoses, and writing prescriptions. What had happened to my passion in preventative medicine? It was after I attended a series of conferences that focused on advances in scientific research around food and nutrition that my passion was renewed. I literally got tingles as I sat in the audience. I was back! Since then, I’ve changed my practice to spend at least 15 minutes of a 45-minute physical talking to, and enquiring about, nutrition, exercise and lifestyle.

However, from the treatment point of view, many physicians still do not look into what we can do with nutrition. We share a basic understanding about diet, but food remains under-appreciated as an intervention point to empower patients about the treatment and prevention of disease.

 

Weaving food and nutrition into medical education

One problem is that in most medical schools, physicians are not being taught the latest concepts in nutrition science. Research shows that doctors currently don’t feel confident enough to counsel their patients about their diets; in fact, more than half of graduating medical students rate their nutrition knowledge as “inadequate”. Nutrition education simply isn’t prioritized enough in the medical curriculum in North America. Another study in Academic Medicine shows that only 27% of 105 medical schools in America met the minimum requirement of 25 hours in nutrition education.

In fact, 87.2% of the Canadian students surveyed in a study said their undergraduate medical program should dedicate more time to nutrition education.

There is demand from Canadian medical students for more nutrition education.  In fact, 87.2% of the Canadian students surveyed in a study said their undergraduate medical program should dedicate more time to nutrition education. While a lot of these students said they were somewhat comfortable in their knowledge about the role that nutrition plays in disease prevention, they felt ill-equipped to counsel patients on dietary requirements across all stages of the patients’ lives.  They also said they have trouble identifying credible sources of nutrition information.

Medical school faculties need more staff who are qualified to teach nutrition. I believe that understanding the role of food as treatment should not be relegated to a few more hours or as a separate course, but woven into the entire medical curriculum. We should talk about nutrition when students study pre-natal health, pediatrics, ophthalmology, oncology, or orthopedics. Fortunately, this has already begun at the University of Toronto thanks to the guidance of a team of physicians including Dr. John Sievenpiper, and to the very generous donation from Johanna & Brian Lawson for the creation of the Centre for Child Nutrition at the university.

 

A trusted and reliable education resource for physicians and patients in nutrition

What about the physicians who are already practicing? I’m currently working with the University of Toronto on accredited nutrition education for practicing MDs and have founded the Rundle-Lister Lectureship in Transformative Nutritional Medical Education. This lectureship is part of the Food as Medicine Series and provides an annual award to a clinician recognized for providing an outstanding contribution to the role of nutrition in patient care. The conferences help to address the knowledge gap in continuing medical education in nutrition; for example, our first Food as Medicine conference focused on the impact of gut microbiome in health and disease. There is a saying that “we are what we eat”. While there is truth to that, I also believe that as more research is tackled, we will further understand how the foods we eat affect our microbiome and consequently, the impact of those changes on our health.

Patients and physicians alike also look to the internet for educational assistance. For doctors who do not have the time for nutrition counseling, or wish to refer patients to reliable and trusted websites, I envision a day when we can refer to a University-affiliated “go-to” web hub.  The University of Toronto is one of the few Faculties of Medicine that has a Department of Nutrition under its umbrella. By developing such a website, the University of Toronto would be in an excellent position to become known as the place for physicians to update their knowledge and for patients to get safe, reliable information about nutrition.

I’m not asking doctors to become dieticians. But physicians are in a unique and powerful position because they can provide advice to patients during annual check-ups or at times of acute illness when it is most likely to resonate.

I’m not asking doctors to become dieticians. But physicians are in a unique and powerful position because they can provide advice to patients during annual check-ups or at times of acute illness when it is most likely to resonate. For long-term change to really happen, the opportunity sits with redesigning medical education for future physicians. They can be taught about the value of nutrition in their clinical practices, and to position dietary approaches as a complement to traditional medicine for the maintenance of health and prevention of chronic diseases.

 

Transforming the hospital meal for sustainability

By Allison Gacad, Loran Scholar and Nourish Researcher and Annie Marquez, Nourish Innovator

 

A meal at a healthcare system is a juggling act of numerous priorities: is it nutritionally adequate for the patient? Does it fit within the allocated budget? Are there a variety of colours and textures on the plate? Among these questions, a new priority is beginning to emerge: how sustainable is this meal?

The most powerful path to being sustainable as a healthcare institution isn’t through turning off the lights or unplugging electronics – it’s in changing the way that patients eat.

The most powerful path to being sustainable as a healthcare institution isn’t through turning off the lights or unplugging electronics – it’s in changing the way that patients eat. From the production of the ingredients to the processing at a factory, to the transportation required to bring the food to the plate, the creation of a meal radiates social, economic, and environmental effects well beyond the person who is eating it. When we amplify this by the thousands of meals prepared, served, and consumed daily in healthcare institutions across Canada, the impact is monumental.

The choices that food service managers make about what is served on the plate ultimately influence global systemic issues of climate change and public health. Despite this immense opportunity for proactive change, not all food service managers are equipped with the knowledge and tools to act in the interest of environmental sustainability.

Nourish Healthcare’s Sustainable Menus collaborative working group is a team of healthcare leaders looking to address this knowledge gap and transition food in healthcare towards sustainability. Through the creation of a practical and user-friendly sustainable menu guide for food service managers, the group is looking  to mobilize sustainable food choices in healthcare and the reduction of greenhouse gas emissions. Below are some of the pathways towards sustainability presented in the guide:

 

Moving towards plant-based proteins

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Agriculture — the system that powers the production of our food — accounts for nearly 24% of global greenhouse gas emissions. However, the production of certain types of foods are more resource intensive than others. Livestock — including red meats, pork, and poultry — contribute to 18% of global greenhouse gas emissions. Large volumes of water are needed for livestock to drink and maintain hygiene. Vast amounts of land are used to produce their feed and even their natural digestive processes directly contribute to the greenhouse gases in our atmosphere.

In contrast, plant-based proteins such as legumes benefit soil ecosystems rather than impair them. Legumes are recognized as “soil building crops” thanks to their properties which improve soil structure, reduce erosion, and increase organic content.

For most healthcare facilities, traditional protein is animal-based and is usually in the form of beef or pork. Transitioning into plant-based proteins can be challenging, but even small efforts can have massive impacts. According to Healthcare Without Harm, “Eliminating meat for one day per week, for example, could reduce emissions by an estimated 1.0 gigatons (Gt) to 1.3 Gt. per year, the equivalent to taking 273 million cars off the road.” Plant-based proteins are also substantially cheaper than their animal protein equivalents, in fact being approximately 4 times less expensive per gram of protein.

 

Less processing, more whole foods

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Chicken nuggets, bags of chips, and microwavable meals: ultra-processed foods have little resemblance to whole foods. They are better described as formulations of industrial ingredients and other substances derived from foods and additives. Not only are these foods full of calories and have limited nutritional value, but the energy and water required for their production is extensive. Processed foods are also a source of ample plastic waste due to the packaging of the products to optimize transportability.

The convenience of ultra-processed foods is attractive in healthcare settings. Pre-packaged portions make it easy to serve clients – but at a cost to nutrition, sustainability, and sometimes even budgets. Instead, looking to whole foods or minimally processed foods such as raw fruits and vegetables or simple baked goods can be beneficial for patients and the planet.

 

Local food, local economies

Prioritizing the procurement of local foods is path that can help meet priorities around creating delicious, sustainable and cost-efficient meals.

In a recent article in Food Service and Nutrition Magazine, Jennifer Reynolds of Food Secure Canada describes the following 5 reasons for buying local food:

  1. Reducing food miles: The smaller the distance food needs to travel, the smaller the environmental impact.

  2. Fresher, more flavourful food: Local food is often harvested only hours before being sold – the freshness results in better taste.

  3. Seasonal eating: When fruits and vegetables are in season, they are at peak flavour and ripeness.

  4. Supporting local economies: Producers directly receive profits and consumers learn how their food is grown.

  5. Transparency: Consumers gain a better awareness of what they’re buying.

 

Reducing waste

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Food waste leads to lost calories, money, and energy. In 2010, the annual value of food wasted in Canadian hospitals was about $45 million. This was the result of either kitchen food waste, where food may be overproduced or prepared inefficiently, or patient food waste, where food is left uneaten and remains on the plate.  Hospital kitchens can use simple methods of reducing waste such as freezing leftover bread or pureeing proteins into soup in order to maximize use of the ingredients purchased.

Reducing food waste is a sustainable action that also meets needs around enhancing patient health and satisfaction. Observing how much and what foods are left on the patient plate can empower care providers to identify signs of malnourishment and support food service managers in identifying recipes that need to be improved.

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Moving forward, it is vital that we see healthy food as synonymous with sustainable food, for the health of the patient, population and planet.

There is no doubt that making sustainable food choices can nourish both patients and the wider environment. Health care facilities which elect to prioritize sustainability in their kitchens will emerge as leaders in public health. As climate change continues to aggravate existing global problems such as food security, infectious diseases and extreme weather patterns, making sustainable food choices is part of the public responsibility of hospitals to reduce the impact of a warming climate. Moving forward, it is vital that we see healthy food as synonymous with sustainable food, for the health of the patient, population and planet.

 

Toward a New Era of Values-Based Purchasing: Welcome to Fasken Law & Buy Social Canada

We are building an ever-stronger team to bring values-based procurement  to Canadian health care. Today we are delighted to officially welcome Fasken Law and Buy Social Canada as project partners to one of our five Nourish collaborative projects.

The values-based procurement team's scan of best-in-class social procurement language is currently underway. Under the leadership of Buy Social Canada's David Le Page and Maija FIorante, the scan will cover provincial, domestic, and international examples of language that harnesses a public buyer's purchasing power to procure foods that support the health of patients, communities, and planet.

With the legal expertise of award-winning firm Fasken Law, led by Kathryn Beck, Vanessa Mui, and Daniel Fabiano, we will bring this research to life by developing and open-sourcing tested language for adoption by health care food purchasers.

We will develop, test, and open-source two sustainable procurement tools: one to support organizations with self-operated food services and one for organizations with outsourced food services. Creation and testing of two procurement tools aims to support the sector to break out of the current cost-driven process that defines healthcare food purchasing. Our goal is to advance more responsible procurement of healthy, sustainable and tasty meals for health care. Similar to our peers in the Nourish Sustainable Menus project, we are interested in the social, economic, and environmental dimensions of sustainability.

Over the next months, we will be recruiting health care sites to test the contract language developed by our team. Please send us a note through the Get in touch form if you are interested in being a beta-test site or would like to become otherwise involved.

With the growing circle of engagement around this project, so too is our confidence growing that we urgently need to bridge the gap between our desire and our capacity to bring our values more fully to life in our public institutions. 

We will develop, test, and open-source two sustainable procurement tools: one to support organizations with self-operated food services and one for organizations with outsourced food services... We urgently need to bridge the gap between our desire and our capacity to bring our values more fully to life in our public institutions. 

We couldn't be happier to be joined by Fasken and Buy Social as we continue on this journey. 

Travis Celebrates Indigenous Peoples Day at Grove Park with a Traditional Menu

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June 21 marked National Indigenous Peoples Day, and to celebrate and honour the day, Travis brought Huron-Wendat and Anishinabek dishes to the Grove Park Home menu. We interviewed Travis to learn how it all came about and to hear his takeaways from the day.
 

What got you thinking about Indigenous food in care?
I never really considered Indigenous food in healthcare prior to becoming a member of the Nourish cohort. After learning more about traditional foods from other cohort members, I realized that there is a lot that needs to be done to promote Indigenous foods in Canada and to educate the public.

Why does it matter to you?
It was important to recognize Huron-Wendat and Anishinabek people. The area is rich in their history, and I believe it was an opportunity to share their culture and cuisine with our residents, families and employees.
 

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I did some research on the Huron-Wendat and Anishinabek foods, and spoke with a family member who is actively engaged in sharing Indigenous traditions.


Tell us about your process to create a new menu for this day.
Initially, I reached out to Kathy Loon and Kelly Gordon, as well as Hayley Lapalme who provided me with some feedback on menu creation. That gave me a good baseline to develop the menu. Then I did some research on the Huron-Wendat and Anishinabek foods, and spoke with a family member who is actively engaged in sharing Indigenous traditions.

What's on the menu and how did you develop it? Where did you source the food?
The menu consisted of Three Sisters Soup, we used a recipe sourced online. We were originally going to serve a maple glazed trout but had difficulty sourcing a suitable cost-effective product, so we went with salmon. From there it was accompanied with blueberry bannock (which was a commercially sourced tea biscuit), maize (corn) and for dessert was fresh strawberries, sourced locally.
 

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How was the menu received?
The menu was received quite well, and the promotion of Indigenous Peoples day engaged our staff to discuss further. We had the adult day program staff even prepare a First Nations treat consisting of warm apple slices, cranberry and berries.

What reactions did residents give? What about staff?
We have a small contingent of Indigenous residents, but the most popular menu item was the Three Sisters Soup. We had numerous staff thank us for doing something to recognize the Indigenous population. It was well received.

Will you do it again? Same or different?
I would absolutely do it again. I didn't give myself enough time to source product. In the future, I would get in touch with a local Native Friendship Centre or one of the many reservations close by to source better recipes and menu item options. It can be difficult to develop a menu in long-term care that is appropriate for an ailing population that we serve.

 
I would absolutely do it again. A few suggestions for others: connect with your local Native Friendship Centre, traditional food specialists, and even the clientele that you serve.
 

What advice do you have for others who are thinking of bringing traditional foods into their own menu?
A few suggestions for others, as said above: connect with your local Native Friendship Centre, traditional food specialists, and even clientele that you serve. Do research on the items you are serving so that you can educate the people you're serving. Have fun sharing and learning!

Thank you Travis! 

Patients and staff enjoy traditional foods at Saskatchewan Health Authority Regina on National Indigenous Peoples Day

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To celebrate National Indigenous Peoples Day on June 21, Stephanie and her food and nutrition staff at Saskatchewan Health Authority facilities in Regina served up delicious traditional dishes to both staff and patients. We interviewed Stephanie to learn about how she and her team planned this menu and what inspired her.
 

What got you thinking about Indigenous food in care?  
Nourish! It was the collective knowledge and the passion of my Nourish colleagues that inspired me to start thinking about how I could incorporate more traditional foods into the menus where I work. I had a moment around the Colton Boushie trial where I thought to myself, ‘If everyone did one small thing to move this forward, we could change things.’ And then I realized, ‘Well, what am I doing?’ So I decided to dedicate a large portion of our new Wellness Garden to Truth and Reconciliation, where we will grow traditional medicinal plants in partnership with local First Nations communities and Elders. Doing this menu was another step we could take to put our learning into practice.

Why does it matter to you?
It matters because many of the people in our care have Indigenous roots and sadly this has been largely overlooked in our menu planning. I believe that every person has the capacity to contribute in a positive way to truth and reconciliation.
 

  Nutrition and Food Services employee, Lee Bannister, dishing up the bison stew for patients at the Regina General Hospital in celebration of National Indigenous Peoples Day!

Nutrition and Food Services employee, Lee Bannister, dishing up the bison stew for patients at the Regina General Hospital in celebration of National Indigenous Peoples Day!


What's on the menu and how did you develop it? Where did you source the food? 
At our Nourish retreat in April, my group had the good fortune to visit the Squamish Lil'wat Cultural Centre in Whistler as a part of our learning journeys, and have lunch from their café. I had the most amazing salmon sandwich on bannock and wondered if it was something we could do in our cafeterias here in Regina. I described it to one of my Food Services Managers (Garnet Roberts), who is also an amazing chef, who said “no problem.” Garnet used Traditional Foods and Recipes from the Wild Side, a publication by the Native Women’s Association of Canada as a resource for recipes.

Our Food Services Manager used ‘Traditional Foods and Recipes from the Wild Side,’ a publication by the Native Women’s Association of Canada as a resource for recipes.

 

With National Indigenous Peoples Day on the horizon, we selected this day for its debut and learned to create a recipe for salmon on bannock sandwich with arugula and a juniper dill aioli. Using bison sourced locally from Saskatchewan, Garnet also prepared a dish of bison stew, served with corn and bannock to honour the day while also celebrating local ingredients. The stew was perfect as it could work with nearly all diet types (although we did have to relax our restrictions for sodium and fat). We served this meal across our four Regina sites to nearly all patients and residents and featured this item in the cafeteria as well. We lost count after 1000 servings! It was a big hit.
 

  Joyce Wong serving up the salmon on bannock sandwich in the hospital cafeteria

Joyce Wong serving up the salmon on bannock sandwich in the hospital cafeteria


What reactions did the residents give? What about staff?  
There was a real buzz in our kitchens. Staff was excited about serving something new and different and we had never really done anything in celebration of National Indigenous Peoples Day before. Many of the staff tried the stew before we served it and they felt proud – proud of our department for making the day special for the people in our care and proud of themselves for being a part of it.

Will you do it again? Same or different?  
We will absolutely do it again, but we will have to find a different recipe for next year.  The bison stew and bannock was such a hit we are planning to add it into our regular menu rotation. As for the salmon sandwich, I’m pretty sure we will see it in our cafeterias again soon – it sold out too!
 

The bison stew and bannock was such a hit we are planning to add it into our regular menu rotation.
 
  Paul Neiman, a cook at the Wascana Rehabilitation Centre (Regina) , proudly displays the salmon on bannock sandwich prepared in honour of National Indigenous Peoples Day. Wascana joined the Pasqua Hospital, the Regina General Hospital and Regina Pioneer Village in this celebration, serving more than 2000 servings of bison stew and salmon sandwiches to our patients, staff, and visitors.

Paul Neiman, a cook at the Wascana Rehabilitation Centre (Regina) , proudly displays the salmon on bannock sandwich prepared in honour of National Indigenous Peoples Day. Wascana joined the Pasqua Hospital, the Regina General Hospital and Regina Pioneer Village in this celebration, serving more than 2000 servings of bison stew and salmon sandwiches to our patients, staff, and visitors.


What advice do you have for others who are thinking of bringing traditional foods into their own menu? 
My advice to others is, especially if this is for a special occasion like National Indigenous Peoples Day, would be set aside your dietitian hat (or work with your dietitians) and relax your nutrient goals for the day. We decided we wanted something special for everyone, including our patients on more restrictive diets (like cardiac and renal), so they too could experience the meal as close to the ‘real thing’ as possible. We made a version with ground bison and veggies so even our folks on soft and minced diets could enjoy the same meal. We were so pleased to hear we got it right, with colleagues from Native Health Services sharing… “that was some top quality bannock today”.

Thank you Stephanie!

Travis Durham wins award for Nourish work on on-site honey production and gardening  

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Nourish innovator Travis Durham and his long-term care organization Grove Park Home was awarded the Advantage Ontario’s 2018 Innovation and Excellence Award, which recognizes innovative programs or techniques in workplace quality and the provision of care or services for seniors.

Nourish led Travis Durham, who was already passionate about obtaining local produce for resident meals, to lead several projects including a resident-focused vegetable garden and on-campus honey production. He started honey production in the spring of 2017, where he invited a local honey producer, Dickey Bee Honey, as an educator and end-producer. Since then,  a private honey label was created with 300 jars of honey produced for sale to the community, leaving enough honey for his resident population for meal service and food production. Travis also wrote an article how to introduce beekeeping and honey production to health care here

 

  Some honey from harvesting our bee hive (Photo from Travis) 

 Some honey from harvesting our bee hive (Photo from Travis) 

 
 A jar of the private label Honey Grove honey. (Photo from Travis) 

A jar of the private label Honey Grove honey. (Photo from Travis) 


Travis also led the creation of an on-site vegetable garden by collaborating with a local company The Growing Connection, which donated a dozen Caja garden boxes, initial supplies and start up labour. The garden boxes were placed on concrete blocks in an enclosed center garden, and a ramp created to make the garden accessible to the resident population. Since then, residents have been encouraged by Manager Barb Caicco’s Life Enrichment staff to spend time in the gardens tending to weeds and picking fresh vegetables. All of the vegetables have been used in the preparation of resident meals. As a next step, the Resident Leadership Team has announced that they will fund the purchase of an additional one dozen garden boxes, start up supplies and labour for Spring 2018.

Travis and his winning organization was presented with a framed certificate and a $1,000.00 cash award at the 2018 Annual General Meeting & Convention at the Westin Harbour Castle Hotel in Toronto.

  Residents at Grove Park Home harvesting kale from the gardens (Photo from Travis) 

 Residents at Grove Park Home harvesting kale from the gardens (Photo from Travis) 

 L to R Mienke Straatsma (GPH), Robert Patterson (The Growing Connection), Travis Durham (GPH)

L to R Mienke Straatsma (GPH), Robert Patterson (The Growing Connection), Travis Durham (GPH)

 


 

Sourcing meat raised without antibiotics: If A&W can do it, why can’t Canadian hospitals?

Health care facilities are on the front line of dealing with antibiotic resistance, named a global health threat by the World Health Organization. Each year in Canada, more than 18,000 hospitalized patients acquire infections resistant to antimicrobials and the “total medical care costs associated with antimicrobial resistant infections have been estimated at $1 billion”annually. However, health care facilities aren’t flexing one of their biggest muscles that could help address antibiotic resistance: their food purchasing power and influence.