Community Dietetics in Light of Covid-19

By Rachel Eldering

When dreaming about my dietetic internship, I never imagined the commute to my first rotation would be so short. It was ten steps from my breakfast table to my computer where I would start my community rotation with Moveable Feast. But, I truly believe one of the best qualities a person can have is the ability to roll with the punches. Many aspects of the internship are different this year, and it’s up to me to adapt and learn as much as I can. I’m so grateful that my community rotation at the Baltimore nonprofit Moveable Feast was able to give me an insightful and meaningful experience while being virtual. 

Every day Moveable Feast provides meals to individuals suffering from food insecurity, which lessens their need to make tough choices like choosing between food and medicine or bills. In order to truly understand how Moveable Feast impacts the community I focused on one specific target audience — the food insecure who also struggle with illnesses. A study from 2013 found that individuals with diabetes that experience food insecurity have increased hospital visits, worse glycemic control, higher HbA1C, and a lower medication compliance (Berkowitz, Baggett, Wexler, Husky, and Wee, 2013)

Moveable Feast’s mission is to provide individuals living with HIV/AIDS, cancer, and other diseases healthy, medically-tailored meals twice a day, seven days a week. It’s important to recognize the term “medically-tailored” as this is a big factor that sets Moveable Feast apart from other meal delivery organizations. The medically-tailored meals are provided so individuals with different nutritional needs can get the food they need to stay healthy. For example, Moveable Feast tailors meals to those who need renal or diabetic diets. Moveable Feast’s core philosophy, and one that really speaks to me, is “food is medicine.” I love the reinforcement that what we eat matters and it impacts our health more than you may think. In order to begin receiving Moveable Feast meals, clients must be referred by a primary care provider. There is typically a waitlist to join the program.

One of the first things I learned in this rotation is how vital volunteers are in the fight against food insecurity and hunger. According to 2019 statistics Moveable Feast has made 656,158 meals and served 4,365 clients. That comes down to an average of 1,800 meals made every day. Daily volunteers helped to make these meals happen. One difficulty Covid-19 presented was the inability to have volunteers. While Moveable Feast is still making sure all their clients get their meals, it showed me just how valuable those volunteers are. 

One of the reasons I am fond of community work is because of the hands-on impact I want to make in people’s lives. I am happy to learn how impactful these dietitians are with their clients. Moveable Feast dietitians are not just providing medically-tailored meals; they are a support system and education source. Listening to the dietitians speak with their clients I could tell how meaningful the relationships were. They were able to banter and speak candidly about a client’s habits and introduce simple goals to steer them in the right direction. I’ve questioned before whether motivational interviewing techniques were really effective. However, hearing this strategy in real life the method felt very constructive and sincere.  

A project that I worked on for Moveable Feast was editing handouts they provide to clients. Some examples of their handouts include tips to eat more fruits and vegetables, renal snack ideas, and seated exercises. The information in these handouts need to be easy to comprehend for the average person. Here is an example of a handout my partner and I edited. 

A challenge I felt with this rotation was my lack of personal connection with clients. Of course this comes with time, but it also confirmed the importance of relationships in community dietetics. Another challenge due to Covid-19 was the inability to make home visits. Typically a Moveable Feast dietitian will assess a client in their home. This is beneficial for a multitude of reasons, including being able to do a nutrition focused physical exam and getting a better understanding of the client’s resources. When meeting with clients in person it can feel personal and comfortable more quickly. Currently, Moveable Feast dietitians are interviewing clients for brief check-ins and full assessments by phone. At first my partner and I would just listen to the dietitians make calls, but we soon started to make calls ourselves. I learned how to move through the online charting system while speaking and listening. I also worked with the dietitians to understand gauging levels of risk. No case was black and white, so it definitely was a learning curve for me. Sometimes speaking to clients over the phone was challenging since I couldn’t pick up on nonverbal cues, such as smiles, frowns, posture, or eye contact. An additional challenge came with how often clients were not available by phone. Many times I would prepare to speak with a client by going through their case notes for 20 minutes and then was not able to reach them. 

When I spoke with clients the conversations revealed so much more than what was in their case notes. It was an important reality check that everyone is dealing with more than what’s on the surface. There are so many factors that influence a person’s food and lifestyle choices. I believe there is never a place for judgement in community dietetics. I’m thankful for these experiences and will use my new skills going forward, whether in my next rotation, my next job, or even my everyday life.

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