By Cristen Scifo

When I used to think about making a positive impact on the environment, all that came to mind was the age old slogan “reduce, reuse, recycle.” Now I can’t think about helping the environment without thinking about healthy dietary changes. As part of this internship, UMD College Park Dietetic Interns have the opportunity to spend two weeks in a sustainability rotation. Prior to starting, I honestly did not find the idea of this rotation to appealing. While I may not make a career out of being a sustainability dietitian, this rotation has had a large impact on my life.

The main focus of this rotation was determining if the current campus dining menu was compliant with something called the “Menus of Change Initiative.” This initiative was created by Harvard and The Culinary Institute of America to attempt to make food service institutions “greener.” It is centered around 24 principles, such as eating more fruits & vegetables, consuming less meat, increasing seafood-based meals, and buying local produce. I created an Excel sheet  to code menu items into several categories: grain-based, poultry-based, vegetable-based, seafood-based, red meat-based, or containing dairy, legumes, or potatoes. Once all menu items were coded, the Excel sheet was programmed to add up how many items were in each category and create graphs that provided an accurate breakdown of each station in each dining hall on campus.

For me, the health benefits of following the Menus of Change Initiative were obvious. Eating more fruits,  vegetables and seafood, while limiting red meat and making smart dairy choices improves heart health and helps us to achieve a healthier weight. Buying these foods locally helps to stimulate local economies. However, I was confused and a little bit skeptical about how changing how you eat could help the environment. This project prompted me to do more research and find the explanation I was looking for.

One of the main ideas I came across as I researched is that raising livestock takes a big toll on the environment. Knowing that too much red meat in one’s diet can also have a negative impact on health, I wanted to know more. According to John Hopkins School of Public Health, only 40% of farmland is used for growing crops. The rest is used for raising livestock. These livestock account for 9% of greenhouse gas emissions in the United States, and around 15% worldwide. The amount of livestock also leads to a large amount of pollutants ending up in water supplies. This often results in a drastic loss of ocean life.

One of the theories behind Menus of Change is that if more professionals in the food service industry limit the use of meat as the main focus of meals, less livestock will be necessary. This will allow more farmland to be used for growing crops meant for consumption, which can also help alleviate world hunger. These sustainable menus also tend to be “plant-forward,” meaning they highlight produce. Recipes may contain poultry, fish, dairy, or even small amounts of meat. Over time, this could result in a healthier diet for the population and reduced disease risk.

This rotation really impacted my entire way of thinking. I never really made a connection between the food we eat and important issues such as climate change. After completing my two weeks at the Sustainability Office, I started making significant changes in the way I eat and now follow a plant-based diet myself. I am truly thankful that this internship provided such an eye-opening experience!

By: Samantha TenEyck

Advocacy is an extremely important part of raising awareness and support for what you believe in. Growing up, my parents always stressed to my sister and me the importance of not only advocating for ourselves, but also for others. As I grew older, I began to realize that being an effective advocate required interpersonal skills, positivity and a strong commitment to fostering change. Entering the dietetics profession, I knew I would have the opportunity to act as an advocate for others in a variety of settings, but feared my voice would not be loud enough. It quickly became clear to me that advocacy is not solely drawing attention to a problem, moreover, it is about listening to and supporting those who are experiencing the problem. Throughout my rotation with DC Central Kitchen, I had the ability to observe how the work of one food hub could amplify the voices of thousands of individuals facing hunger in the heart of DC.

DC Central Kitchen, founded in 1989 by Robert Egger was one of the first facilities in the area to combine efforts against hunger and joblessness. Once trained in culinary arts, previously jobless adults would collect food that would otherwise be wasted and produce nutritious, balanced meals for shelters and nonprofits. Years later, DC Central Kitchen is a food hub that works in a variety of settings to provide millions in the community with access to safe, nutritious food. DC Central Kitchen continues to perform culinary job training, partnering with 76 community meal agencies, 15 schools and 71 corner stores in the area to provide healthy meals, produce and snacks. Throughout my rotation with DC Central Kitchen, I had the ability to work with the Healthy Corner Store Initiative, a program that aims to expand nutritious food access in corner stores located within DC food deserts. Collectively, DCCK works to clean, cut and package produce and healthy snacks to be sold at wholesale, or below market price to corner stores in the area.

                                                                                                                  DC Central Kitchen

My partner Cristen and I were given a multitude of projects to complete for Healthy Corners throughout the week, including calculating the nutritional information and creating health factoids for items that the kitchen plans to implement on their new food labels. It was very exciting to have the opportunity to apply our nutrition expertise, however, I found the time spent in the actual corner stores to be particularly valuable. Cristen and I were sent to a Ward 7 corner store, where we were to set up a booth and provide individuals with information regarding the “$5 for $5” fruit and vegetable initiative. Made possible through the Food Insecurity Nutrition Incentive (FINI) Grant Program and DCCK, this initiative allows individuals who spend $5 of their SNAP benefit funds in the corner store to receive a voucher worth $5 towards fresh DCCK produce.

                                                                                                                  DC Central Kitchen

Attracting customers with our fresh fruit samples, Cristen and I had the ability to meet few of the wonderful individuals residing in the Ward 7 community. The residents were overjoyed to hear about the initiative, stating how difficult it can be to find affordable, fresh produce in the area. Thanks to DCCK, we were able to direct residents inside to the brightly lit fridge where the fresh packaged produce flew off the shelves. Looking around, it was clear that the standard corner store offerings were mostly inexpensive, convenience items packed full of sodium and sugar. By providing marketing support, technical assistance and nutrition education to stores and individuals in the area, DCCK hopes to foster healthier purchases among corner store customers, at an affordable price.

                                                                                                                  DC Central Kitchen

Fortunately, we had the opportunity to work alongside the individuals who make these programs possible. Rather than functioning as solely a food provider, DCCK actively works to form relationships with those facing food insecurity through extensive community outreach. By forming these relationships, DCCK can solicit valuable input from individuals in the community and offer solutions to the root causes of hunger and food insecurity. As a result of successful outreach, DCCK has effectively identified the needs of individuals living in food deserts and provided a solution that benefits SNAP recipients, corner store owners, and even DCCK. Through this experience, I have learned that advocating for a cause, whether it be legislative, corporate or community advocacy, all starts with being an effective listener and relentlessly pursuing your passion for achieving change. I believe that as a future dietitian, I have endless opportunities to advocate for others and I strive to do so.

-Jackie Choffo

“For your last task, you will create a nutrition education program and present it to one of the pantry sites in Montgomery County.” My heart started to race when my preceptor from Manna Food Center uttered this sentence. An entire nutrition education program? From scratch? For 120 people? What could go wrong.

It turns out if you break a big picture idea up into smaller, achievable tasks, it can be quite manageable. First task: decide on a topic. My internship partner, Isabella,  and I bounced a few ideas around that were simple to expand upon and eventually settled on the vegetable food group. Second task: develop a key message. Eating a variety of vegetables increases the variety of nutrients you are taking in, so why not emphasize colors? After that we were rolling. We made graphics to emphasize the colors of seasonal produce and the health benefits associated with them.  To make our table interactive, we decided to include a tasting to showcase how simple it is to incorporate vegetables into meals.

Working with community groups has always been a passion of mine. Connecting with people one-on-one can be impactful, but also intimidating. There isn’t a stage or podium to hide behind when you are shaking someone’s hand and asking if they want a sample of your vegetable salad! Luckily, during my second week with Manna Food Center I was able to interact with a real live audience at the Glenmont food pantry in Silver Spring, Maryland to further develop my interpersonal skills.

On the day of the presentation, I came prepared with all of the materials  Isabella and I had created. We brought in colorful copies of “healthy hues for you,” recipe printouts, food models, and of course, the food samples. We were stationed off of the main hallway in a small room where the carts were held for the participants to shop with. Our table was proudly decorated with a bright red Manna tablecloth and displayed our education materials and hands-on activity. We were ready to go!

Since we weren’t visible to the people waiting in the check-in line, Isabella and I brought the samples and handouts to them. As people were eating the sample of black bean and tomato salad, I could really engage them in a discussion on the variety of vegetables we used in our recipe. To involve them in further discussion, I would ask them questions such as “which vegetables do you like to use when you cook” and “have you gotten any vegetables from Manna that you didn’t know how to prepare.” It was great hearing what people’s individual likes and dislikes were. Many people would light up when they listed off what they have received from Manna; some were vegetables I had never heard of before, like watermelon radish.

Along with the nutrition table set up in the room, there was a cart with free children’s books for the taking. While some parents were checking in, we would ask kids if they wanted to peruse the books. I was usually greeted with a bashful smile, a nod and then the tiny tots would dash over to the racks. This is when the food models really came in handy. I asked one girl if she recognized the vegetables I had displayed or which ones she liked. I found out she LOVED broccoli and couldn’t get enough of baby carrots. Bell peppers weren’t her favorite but the squishy bell pepper rings were fun to play with!

The main take-away I had from the evening at Glenmont was that people generally like to talk with you. I enjoyed conversing with the participants, and even learned about new ways to incorporate vegetables into my own diet! People can be at the food pantry for all different reasons, but talking about vegetables doesn’t have to put them on guard. I was able to practice connecting with a varied audience. Speaking to the participants about something relevant to their life was engaging and helpful for them. I had prepared talking points, but the most meaningful conversations involved me responding to the comments other people made about their food choices. Numerous people ask for the recipe for our sample black bean salad, and even said they were going to try it at home! Being a part of the nutrition education team at Manna was a worthwhile experience, and one I will never forget.

By: Stephanie Jean

At nearly every hospital across the nation, there is a rounding system that medical professionals use to provide efficient care for the patient and communication between providers. You may have seen a version of this on popular medical TV shows such as Grey’s Anatomy. I have seen my share of medical shows, but until I took part in real life rounds during my clinical rotation, I never really understood how important they are. As an enthusiastic intern with very little hands-on clinical experience, I was somewhat new to the idea of rounding. What are we going to talk about, and why are there so many different medical professionals here, I wondered as I gathered for rounds on my first day. My rotation gave me a solid understanding of the multidisciplinary team, and what rounding on patients means.

The multidisciplinary team can vary from hospital to hospital, but at my rotation site the team typically included a pharmacist, nurse, doctor or physician’s assistant, case manager, and dietitian. The nurse begins by presenting the patient’s case to the group. Much of this included medical terminology that I had heard before, but sometimes a quick Google search helps me piece the picture together. I found it very useful to have a small spiral notebook in my lab coat to jot down notes that I could refer to later. The nurse also discussed any medical procedures and labs that were done, as well as the results. Once the nurse finished presenting, the doctor or physician’s assistant provided feedback and the plan of care for the patient. Typically, this was when other providers  chimed in to reveal their plan of care (if pertinent to the patient). Depending on how long the patient has been there or the complexity of the case, this may include almost every member of the multidisciplinary team.

The goal of the multidisciplinary team is to provide efficient patient care that is strengthened when everyone works together. However, even though we all share the same goal, we have our own way of achieving this goal. What does the dietitian do for the patient that is different from everyone else’s scope of practice? The RD focuses on the patient’s weight status, nutrition status, adequate or insufficient oral intake, medications that may have nutritional implications, electrolyte imbalances, and so much more. These considerations are crucial to the patients care, and at times are instrumental to the patient’s recovery. Not every hospital includes RD’s on rounds, but I believe dietitians are a valuable part of the team who can utilize medical nutrition therapy, provide the team with greater detail about a patient’s nutritional needs and improve outcomes.

Each hospital is different with their rounding system and how often they round on patients. At my hospital, the dietitian is required to be on rounds every day and for every patient. The hospital is on the smaller side, so rounds included as few as 30 patients per day. The team tried to be as efficient as possible by ensuring that everyone was on time for the commencement of rounds, and with very little distractions. During my rotation, the rounds I participated in began at 10:00 AM. My work day started around 7:30 AM, so I had enough time to look up my patients for the day and see a couple patients before rounds started. This taught me the importance of time management, and how every minute spent is valuable to my workflow. Looking up my patients beforehand, if even briefly, prompted me to begin thinking about what care my patient might need and what questions I may need to ask. Rounds were one of the only times that the team was together at once, so it was an ideal time to receive additional information that may not be in the patient’s chart yet. Even though every provider is not present during rounds, I could find out what providers would be consulted for the case and how their services will optimize patient care.

During my clinical rotation, I developed an appreciation for the symbiotic relationship between the interdisciplinary team and patients.Dietitians provide professional and expert advice, but it is always interesting to see what other providers recommend for the patient as well. To gain even more from my clinical rotation, I have

used this experience to learn about other professions, and their role in critical care. I am fascinated by the  various ways in which patients receive care in the hospital setting, and how it largely impacts outcomes. From admission to discharge, providers are working together to optimize patients’ health, and each provider has a valuable role in achieving this. Together, we all leave an impact on the patient and our daily efforts ensure outstanding patient care.

 

I was right in the middle of my rotation with the USDA when the government shutdown. The shutdown began right before the holidays and I thought surely the government would reopen by the time break was over on January 8th.  However, break ended and there seemed to be no signs of the government reopening anytime soon.

A few days before we were to start back at our rotations, I received an email from our director telling me she had found a backup rotation for the time being.  I was to meet with a new dietitian who provided nutrition education for firefighters and police officers. My first thought was, “that’s a thing?” I met with my preceptor, Megan, at the Montgomery Police Department where she had a meeting and later we went to a fire station for a presentation. The presentation was informal allowing the firefighters to feel comfortable asking questions about implementing nutrition in their lives based on their needs. Megan also included nutrition information about heart disease specifically as this population is at higher risk.

It wasn’t long before the firefighters were called and I found myself jumping into the back of the fire truck with them!  With a rush of excitement I saw just how imperative it is for these first responders to always be alert and ready to go with less than a moments notice.

When we arrived at the scene we soon learned our advanced life support firefighter team would not be needed. The call ended up being for a basic life support issue and another team was already present. I found it interesting that Montgomery County uses a clinical decision support tree to determine which personnel team is to be sent to each scene. Whenever the patient or victim states they are having trouble breathing it triggers the need of an advanced life support team as well as a basic life support team. In class, we often talk about using health informatics tools to improve outcomes  and I was grateful to see a real life example at play.

Prior to the call we were discussing how the fire fighters sometimes struggle to make healthy dinners as they often depend on eating out or are confined by barriers such as time and money. Instead of returning straight back to the fire station we took the opportunity to stop at a grocery store to pick up ingredients for dinner and I was excited to be able to throw in my two cents.

With time being uncertain, everyone split up once we arrived at the grocery store. The main focus of the meal starts with the protein. Chili was on the menu that night and I was surprised to see that lean ground turkey was the protein of choice instead of ground beef. While others were grabbing sides, I stuck with the captain as we scanned the isles for canned goods, which would be the bulk of the meal. He asked me questions regarding nutrition of the canned beans. I shared with the captain that it isn’t necessary to buy low sodium beans as rinsing and draining them is very effective at reducing the sodium. Luckily we were able to get all of the items needed without getting another call. This seems to be a typical occurrence,  as they told me of a time they went to the grocery store three times in just one day, always leaving empty handed due to a call. Understandably they resorted to eating out that night.

When we arrived back at the station the firefighters got to work deciding to make the chili in a crockpot. First off they had to brown the turkey. The turkey had been in the pan for less than a minute when they got another call and they were off back into the fire truck. It was a good thing my preceptor and I were there to turn off the stove and crockpot and get the turkey in the fridge in case they were gone long. Food safety, I realized, is another topic to cover with firefighters.

Though I wasn’t able to help with the rest of the meal preparation, I was pleased to know they were able to finish cooking their dinner and enjoy a hearty bowl of chili with a side salad.  The captain even sent me pictures of the finished product and gave it two thumbs up!

Lucky for me, I had the opportunity to cook a meal for a different station of firefighters the next week. My preceptor and I got to work in the surprisingly well-stocked kitchen, cooking up a Cajun Chicken Pasta dish with a side salad. The dish was loaded with veggies and made with whole-wheat pasta. As we sat down for the meal I was nervous to see their reactions. Yet, as I saw them go back for seconds, and even thirds, I knew it was a hit. Better yet, they saw how quickly it all came together and realized cooking healthy doesn’t need to be complicated or expensive.

 

 

The value of dietitians is being recognized more and more with each day as this experience taught me. It is because of positions such as Megan’s that dietitians value is becoming more apparent and opening new doors for future dietitians.