Now that I’m finally feeling better and speaking more Spanish, I’m ready to start doing some nutrition work. The Nutrition Coordinator at the University has been extending herself to help me gain experience over the summer. She put me in touch with a nutrition professor, Isa, who is fabulous. She’s young, experienced and best of all… speaks decent English. What more could I ask for in a mentor?
My priority now, is to continue learning Spanish – but more specifically, begin to build nutrition vocabulary. It won’t be helpful for me to head back to the states and not being able to use Spanish in a future job. By the way, quick side note – R. found this amazing book for me. It’s a dictionary of foods and gastronomy words from Latin America. YES, such a thing exists! For example:
Jugo: liquido que se obtiene de los vegetales por presion. Tambien el que se desprende de ciertas carnes por efecto de calor. Tambien suco. c. suc, e. zuku, g. zume, f. jus, i. juice/gravy p. suco.
Maybe I’m a total dork but I think it’s amazing. Obviously the only problem is, the definitions are not in English, so unless you speak Spanish... this book may not be helpful for you. In case you are interested, this is the information
Vivancos, Gines. Diccionario de alimentacion gastronomia y enologia Espanola y latinoamericana. Grandes Mauales Everest. Spain.
If you happen to know that the equivalent exists in English, please please please contact me!
Back to my work with Isa – so as of right now, it’s still a little limiting on what we can do considering I only speak a little Spanish. Once a week she arranges a meeting with the nutrition department of hospital or other nutrition-related establishment. Then I have the chance to get a tour, see the kitchens, ask questions and all that jazz. It’s similar to the course I took in Puebla during January… tours of hospitals but those of course were all in English. Now I have the opportunity to be on my own and practice Spanish – also the meetings are specifically nutrition oriented, whereas in January their were public health students and dentists, so the tours and questions were much more general.
Since we had a cancellation on our trip this week, the only experience I can tell you of was our visit to Hospital Puebla. By the way, there are A LOT of hospitals in the state and city of Puebla. I can tell you that I was generally impressed by all of them for different reasons. Hospital Puebla is fairly new, and the nutrition department consists of two women. (Well, the one the we met with seemed very young, probably not much older than me and she looked younger). The hospital is fairly large (about 7 or 8 floors), but at the time we visited they only had 10 patients receiving meals. On the weekends they tend to get a little busier and can have up to 25 patients that need meals. The meals are breakfast, lunch and dinner, served at the expected times. The nutritionist who was giving us the tour first took us into the kitchen, where the meals for the cafeteria as well as for the patients are prepared. Interestingly, the hospital contracts a private company to be responsible for the food – so the food is actually cooked by chefs. Trust me, this is very unusual and only possible because Hospital Puebla is a private hospital. And the food smelled awesome. So jealous.
As great as this is for the quality of the meals prepared for patients, it also causes issues in the nutrition department. The main problem being: the CHEFS are the ones who make the menus. Periodically, they send a list of meal options to the nutritionists who can decide what gets served to the patients, but that is leaving little room for cooperation. So the food may taste fabulous but the nutrition quality is at risk. I’m not doubting the ability of the chefs to cook nutritionally sound food, but they are not trained to know which types of foods are beneficial or harmful to a patient with a certain condition. I was impressed that one of the chefs had a personal interest in renal disease, and made the effort to educate her on the nutritional aspect of the disease. However, this was her personal interest and does not imply that the other chefs are as interested in the nutritional quality of food for patients.
The job of the nutritionist on staff is to send the kitchen a list of patients, with room numbers and the TYPE of diet they are issued to receive. From what I can tell, the diets are your standard – normal, bland, liquid or diabetic. The nutritionist was pretty vague as to what foods were included in each type of diet – and remember, a lot was lost in translation (although Isa did her best to fill me in afterwards). From what I can recall, a liquid diet consists of: jugo de gelatina, consume de pollo, te and avena. A diabetic diet was obviously low on carbs, no fruit and low fat. “Dieta blanda” is generally foods with little flavor – like chicken with no seasoning, potatoes, rice – nothing spicy, salty, sweet. There were a few specialized diets mentioned which included: high fiber, nephropatic, low sodium and restricted (which I didn’t get around to asking what exactly “restricted” entailed). She didn’t describe which foods went into the special diets.
We also briefly discussed how there are different procedures for preparing food for cancer patients. Chemotherapy and radiation treatments are meant to kill cancer cells, but in the process they also kill healthy cells in the patient. This process of constant stress to the body, leaves the person immuno-compromised. In essentials, a person undergoing cancer treatment has a lower ability to fight off bacteria – which makes it much easier for them to get sick and die from an infection. What does this mean for nutritionists? It means that we are responsible for ensuring that the food served to cancer patients are safe for consumption. Extra safe. The nutritionist at Hospital Puebla oversees the preparation for food destined to a cancer patient. First the kitchen is sanitized and no other foods are prepared at the same time. Only the food for the cancer patient in a very clean kitchen. They are extra careful not to cross-contaminate, use food from safe vendors, and cook all foods to the correct (or higher than correct) temperatures to ensure that the patient will not get sick.
The other responsibility of the nutritionists is to visit patients who have been referred to them by a doctor. Unfortunately, this is not always the best scenario as many doctors do not respect nutritionists (as I mentioned in my last blog). The world of health sciences is slowly evolving, but it’s not always common to see doctors including nutritionists in their team. So, at Hospital Puebla, if a doctor sees that a patient could benefit from meeting with the nutritionist, he will write a referral. The nutritionists visit these patients, asses what the problem is, learn what kind of foods (if they can eat) they prefer and make periodic follow-up visits.
One thing that I certainly did NOT like about the hospital, was their patient room assignment. On the one floor we visited, there were some maternity patients, the neonatal room, and one man who had kidney and gastrointestinal issues. A little separation is needed, especially from the babies. Speaking of the preemies, I found it interesting that the nutritionists were not responsible for them in any way. Feeding was the responsibility of the nurses – and the neonatal room contained a special room for milk storage.
Our visit ended after the tour of the kitchen and one of the floors with patients. Considering they only had 10 overnight patients I’m assuming there weren’t any patients that were seriously nutritionally-compromised, otherwise the nutritionist might have taken us to meet with them.
Unfortunately, I can't give you a personal comment on what I really thought of Hospital Puebla from a nutritional standpoint. It didn’t seem busy enough to get an inside look at how well department works and I wasn’t able to tell what the nutritionist actually does (especially when there are no patients who have been referred by a doctor). I’m not doubting their abilities at all - there's just no way for me to form a justified opinion after such a brief meeting. The visit was beneficial in remembering the differences between public and private hospitals. I mean seriously – they had trained CHEFS cooking the food. That is hardly likely in a public hospital. It was spacious, clean, new, quiet and even had a restaurant area. Certainly a nice place to stay as a patient but I’m not sure how much “experience” I would gain as a regular intern.
INTERNING ADVICE:
- Ask lots of questions, even if it’s stuff you think you should know. Don’t be embarrassed to ask when you are unsure.
- Not all hospitals were created equal – literally. There is a difference between PUBLIC and PRIVATE.
- Visit as many hospitals, nutrition departments and nutrition settings as you can, and come prepared with questions!
- Try to work with the kitchen staff in preparing meals of high nutritional quality.
- Walk away with a better understanding of our field after every interning experience.
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