Tuesday, April 16, 2013

Nutrition Education

Last week, I had the opportunity to shadow a very smart man at a clinic in Cite Soleil. Two weeks ago, one of the kids at Grace Village told me about his English teacher (and the piano player at our church) who was teaching them a bit about nutrition in school. Turns out the part-time English teacher also works at a clinic teaching nutrition education and talking with individuals about their health problems. When I heard about this, I couldn't resist the opportunity to introduce myself to the teacher at worship the following Sunday. We exchanged contact information-- I got a hold of his people and my people. Before I knew it, plans were arranged. Tuesday afternoon I headed to Port-au-prince for the night, where I anxiously awaited to get to the clinic the next morning.
My view in PAP. Tent cites...

Ready to roll!

The Healing Haiti team was heading to Cite Soleil Wednesday morning to deliver water to the people living in the slums --so I hitched a ride with them. I had some idea where we were headed, based on the directions that I was given from my contacts at the clinic. I had been to Cite Soleil many times before, so I could pretty much picture the location in my head. Not long after entering Cite Soleil, our  taptap pulled over to the side of the curb and our driver ran-up to the compound across from a market to see if it was my final destination. Soon enough, I was out of the taptap and making my way into the compound.

Upon arriving at the doors of the clinic, the escort asked for our contacts and we were on our way! I was so excited to be there-- to meet all the Haitian workers and to tour the clinic. We were informed that  about 150-200 people are seen at the clinic everyday and that they often have to turn people away. People of all ages come to the clinic with all sorts of aliments. Many clients have things like TB, anemia, Type 2 diabetes, high blood pressure, heart burn....   conditions that can be prevented.


Lab tests

After our tour, we made our way to a building across from the main clinic. People of all ages were starting to gather on the benches. Once the crowd settled in, my friend that works at the clinic started to talk to them about health/ wellness and nutrition. He followed-up with answering individual questions. He asked me if I wanted to talk, but I just wanted to stand back and observe him at work. He did awesome! I was impressed with how much information he knew and how personal and engaged he was with each individual. My favorite thing he said to them was, "Medicine can't do everything for you." He talked to the people about reading food labels, eating natural and wholesome foods, using less salt/ oil/butter, drinking less energy drinks and pop. After I while, I started to engage with the people in the space. I talked with them about physical activity and how it is important to get your body moving. I showed them a few things they could do without a lot of space-- jogging in place, push-ups, jumping jacks... etc. I also talked with a few people who had individual questions and concerns. I think the escort with me was enjoying his time with me at the clinic too. Soon enough he was answering people's questions. I asked what he was saying to them, and he was spot on. Hmm... I might have a nutrition team in the works. I am scouting.

The nutrition Team!

A great teacher!


Later on, my friend that works at the clinic said to me, "People can't believe in medicine, people need to believe in food." Amen, amen!!! what you put in your body (or don't put in your body) could be killing you slowly. For people with limited income, it is especially important that they choose some of the most nutritiously dense foods to invest their money in so that they can maximize their daily nutrient intake. In my opinion, if you have little money---there isn't wiggle room to buy sweets and desserts all the time. Most days, you better be investing in the foods that are going to ward of disease. Unfortunately, I find that many people in Haiti are choosing to spend their money on less nutritiously dense foods (nutritiously dense in terms of micronutrient content) and place higher emphasis on quick-convenient, sugar loaded, and highly salted foods. I just want to sit down with people and have them SEE that if they didn't buy sugar for their juice, ate the fresh/natural fruit instead of juicing--they would ultimately save money and could buy something more nutritious than sugar (ie. avocados, spinach leaves, bulgur). That's what we did at our feeding center. By cutting out the juice, we have saved money by not needing to buy ice and as much sugar, which has allowed us to have more money to increase our purchase of produce. It's all about perspective, planning, analyzing, and education.
medication... after medication... after medication. Eat well, now and prevent this from happening.

Now this is my kind of medication. 

My new friend informed me that many people in Port-au-prince (PAP) eat more convenient and processed foods, unlike the people on the country-side. I have observed this too. When I had asked a few people in PAP if they knew how to make Tchaka (a traditional Haitian soup), many of them didn't know about it. I was surprised. The traditional Haitian foods and "slow-cooking" foods have been lost with the transition to city life.

At about 11:30 AM, I had the chance to sit in an all-staff meeting at the clinic where the staff was discussing diabetes. The Haitian doctor at the clinic did an awesome job explaining to the staff about what diabetes is and how diabetes impacts all parts of the body. My friend gave a talk about nutrition--  how nutrition can help in the prevention of diabetes and how it is important in the management of diabetes. He was spot on with his talk and did an excellent job explaining to everyone the importance of good nutrition. Later on I was informed that many of the staff at the clinic  had blood glucose tests done earlier that week, and many of the staff were at risk for diabetes. Again, this wasn't overly surprising to me based on the nutrition-transition I have observed here in Haiti.

Throughout the day, my friend at the clinic was handing out Oldway's African Heritage brochures to all of his co-workers.  Unfortunately, all the brochures are in English (at this time), but I think it is helpful for people to see pictures of what their daily dietary intakes should like. The wonderful thing about the pyramid is that it has pictures of foods that are native to Haiti! My mission in Haiti is NOT to Americanize the Haitian people--many American resources and books are well, American. I am so thankful for the Oldway's materials because they have been a great asset to my mission here in Haiti: helping people to have good health through their native and cultural foods.

In the afternoon, we made our way to the pharmacy area to meet with people as they picked-up their medications. My friend meets with people as they picks-up their medications and asks them about what they should be doing with their dietary intakes in addition to taking the medications. I joined him. It was a very informal way of "counseling" people on their nutritional needs, but it works. Any opportunity to engage individually with people is better than none at all. We found three ladies sitting on a bench near the pharmacy, and we started to talk with them about their medical conditions.  I let my friend engage with the clients first, and then I helped him to "dive-deeper" by asking them more questions about what they were eating and how they were preparing their foods.
This is where we would talk with people individually. 

My friend started out the conversation by asking them, "What are you supposed to limit in your diet?" and one lady said, " salt, not a lot of Maggi, reduce the amount of fat." ... okay, good. She learned something. I asked her if she cooks for herself and if she does, is she preparing her food with a lot of Maggi. She informed me she does cook for herself and that she doesn't use Maggi or a lot of salt (even though later in the conversation, I found out she does use Maggi). Throughout the course of the conversation, one of the ladies talked about her acid-reflex (this is another common problem in Haiti). She told us that when she gets acid, she purges in order to minimize the acid-reflux problem. My ears perked-up, she what!? A quick fix to a problem that also cause more damage to the esophageal tract, the teeth, and even the weakening of the sphincter (the flap between the mouth and the esophagus). I couldn't imagine that purging would be a good long term solution to her problem. We talked about foods that cause acid, and how to better control the acid-reflux. We continued on to talk about her dietary patterns. "So what is the first thing you typically eat each day....", I asked her. (at this moment a quick memory of my professor at St. Ben's popped in my head. She said this frequently in her lectures about nutrition counseling). The lady responded, "Soup--carrot soup" and then she added (in creole of course).." with spinach and olive." Okay, great... but what else is she not telling me. I pressed-harder. "What else do you put in your soup? Do you add any salt, Maggi, butter, oil?" She told me that she doesn't use a lot of oil, she does use Maggi. We continued on to the next meal. Naturally, rice and beans. I knew what things to ask her about with this one. We dove deeper into how her rice and beans were being made. Maggi, salt, butter, oil.. and from what I can assume (based on what I have learned from many people here) these ingredients were probably being used in excess. These are the things that add "flavor" and "enhance" the foods, and most people don't know that serving sizes exist for them. I talked with her about just using the oil, and not buying the butter. She can still use fat in her diet, but with limited nutrition-education everything becomes an all or nothing principle. So I say buy one and don't buy the other-- it not only reduces the amount of fat they are using, but it saves them money too. We talked about this in our session. I showed the ladies what a serving size of oil looks like with my thumb. A small amount of oil contains about as much energy as a whole banana. We talked about the importance of fat in the diet, how foods have different components and energy.

Counseling session

Towards the end of the session, one of the ladies stood-up in the group. She pulled up her shirt, grabbed a roll of skin on her abdomen and shook it. She asked me how to get ride of it. The lady was pretty overweight, which puts her at risk for several chronic diseases and joint problems. We talked about energy balance: energy in must equal energy out, otherwise you either lose or gain weight. We talked about energy in food and about physical activity. The lady was pretty immobile, so I showed her some simple moves she could do to get her body moving. I told her moving any part of her body was going to be better than not moving at all.

Showing the ladies the African Heritage Pyramids

During our counseling session, my friend and I have the ladies a brochure to show them the African Heritage Pyramid. It was a really useful tool. We talked about all the different foods in Haiti--avocados, spinach, squash, sorghum, cornmeal, beans, tubers, yams, cassava, peanuts, coconuts.... and we talked about using fresh foods to flavor meals. Focusing on plants, eating fish about 2 times a week, and using oil/sugar/salt within reason. At the end of the session, one of the ladies looked at the pyramid and said to me, "when I was little, we never used Maggi." Boooom. I lit-up inside. She was getting it. The whole talk about heritage and the past was resonating with her. My hope is that she actually took that message to heart and thought about the "Oldways" people used to cook, eat, and live in Haiti... before the western and inner-city influence.

The rest of the day, I spent with the escort. We got our blood pressure taken for fun, talked with some of the other staff, and I even taught him how to read a food label. We talked about some ideas bouncing around in my head with nutrition education in Haiti, community outreach and cooking class, and helping people get access to fresh "fast-food" at an affordable price. It's one thing to get the message out there, but it is another thing to make the suggestions and advice available to them. I am still praying about connecting the dots to my bigger visions. In a country full of opposing forces, my messages, my marketing, and my strategies must be BOLD, STRONG, AND LOUD.

I have good blood pressure!

My experience at the clinic was amazing. It gave me reassurance that everything I am doing in Haiti with the children, especially, is important and needed. Hearing people talk about what they eat, about their chronic (but preventable and maybe even reversible) health conditions has given me courage to keep on being BOLD and STRONG in my mission. People in Haiti need nutrition education. While it is important at any age, starting with the youth and the young adults is critical. "Catch" them while they are still learning and acquiring new taste. Teaching kids to like their fruits, vegetables, and whole grains is a great place to start. If they acquire a taste for whole, fresh, and natural food young, the hope is that they will continue to seek these foods as they age. We have noticed that our children no longer complain about the meals. For a while, we did have "food wars" with the kids and yes--they still stick their nose up in the air at new foods, but they are getting used to trying new things. The kids are learning to enjoy trying new things and expanding their taste-buds beyond rice and pasta.  The kids are also learning not to be food perfectionist. For example, the other day at breakfast we were unable to "blend" their bulgur smoothies like they usually prefer because the blender was broken. The kids had to eat the bulgur whole with milk and spice, but they didn't complain like I would have expected them to several months ago. That same morning, I brought out a big bag of flax seed and asked the kids if they wanted to mix it into their bowl of food. I was surprised by how many said yes! I had kids swarming around me-- hands reaching out for me like I had a big bag of candy. I was shocked. They were eager to try the flax seed. I guess that's what happens when you are persistent with the kids and you allow them to participate in meals... they learn to adapt, to appreciate, and even seek-out "new experiences" with food.

The adventurous kids.

The need for PREVENTION  of disease is present here in Haiti. There is elevated cases of chronic disease existing in the same context of malnutrition. When people have access to food, my concern is that they are choosing to eat what they know and  like, but not necessarily what their body needs in order to ward of disease, increase immunity, and potentially save  money.

No Maggi in the food for almost two weeks!! I am happy! No more Maggi!

My daily medicine. 

Nutrition EDUCATION is the "food" for the people. Knowledge is power and it can help individuals make informed decisions about their life. Without knowledge, especially as it relates to survival skills (which include eating and eating behaviors/ patterns), an individuals' quality of life will greatly suffer. Malnutrition has a  cyclic effects--- lack of a well-balanced diet decreases immunity and increases risk of disease, which can further cause an increase in expenses for medical visits and medications, and inability to work or go to school......which further drives the cycle of poverty.

I love Haiti.

Now watch this--- A TED talk by Jamie Oliver. He places a lot of emphasis on obesity, however, anyone (regardless of weight or size) is at risk for chronic health problems with poor lifestyle choices. The video is worth watching. His most important message: TEACH KIDS ABOUT HEALTHY FOODS AND TEACH THEM GOOD "OLD" HOME COOKING.

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