When the plate doesn't look like yours.

The last few weeks of learning has made me reflect further on nutrition care for vulnerable populations and the importance of having care providers who can relate to the populations they serve. I recall a time a few years ago when I worked a locum position at our local community health centre. During my time in this role our centre provided care to several Syrian refugees. This provided some interesting learning opportunities and some challenges for me. I had not had the experience of working with a translator over the phone while the patient is in the same room before and was feeling quite overwhelmed by the process. Lucky for me, the patient had visited the health centre multiple times before our visit and was quite accustomed to the process. In the end this aspect of the care went rather smoothly, however I cannot help but think about how limited my knowledge was of her traditional eating habits and foods. As well, I was working with the previous model of Canada’s Food Guide which has been criticized as being even more Eurocentric than the current model (Lapum et al. 2020).

Certainly, it was not my intention to have her feel like the food she was eating was deemed “unhealthy” because it did not fit on the food guide. Throughout our time together it became clear that her diet in Canada was much different to what she was accustomed to eating when she lived in Syria and she was struggling with her weight increasing since she had arrived in Canada the year before. This patient had limited to access to grocery stores and a very low budget to spend on food. Her daughter had mentioned that she was eating more packaged foods than she had ever before because of this.

As I reflect on this situation, I cannot help but feel that I did not utilize the patient-centred approach I had prided myself on in the past. Given the language barrier and my apprehension of using the translator service, I was not able to build the rapport I would have hoped. I remember feeling stressed and anxious about the experience and not wanting to take a lot of the translator’s time, which limited my capacity to learn more about the patient, which would have been helpful in supporting her with the education (Lapum et al. 2020).

The more I learn about health and our experiences working vulnerable populations I realize that I could have done more to learn about use of the translation service and perhaps spoken ahead of time with her daughter who spoke some English. Or utilizing a food guide in her language would have been helpful if one were available. Finding ways to meet her needs and getting to know her thoughts on adjusting to the food available to her instead of just getting down to the teaching based on typical practice would have likely been far more useful (Lapum et al. 2020). Having time scheduled to follow up and keep the session shorter but more often would have been far this overwhelming for myself and for the patient.

Health Canada has put a lot of effort into supporting the idea that including culture and traditions can be healthy (Health Canada, 2020). When I had reviewed the food guide with the patient, she then spoke about her old eating habits in Syria as being ‘unhealthy’ as they were different than what was depicted in the guide which is a common experience by newcomers (Lapum et al. 2020). Yet, she had gained weight because of the change to her lifestyle and eating habits since she had arrived.

Continuing to utilize a patient-centred approach to nutrition education is essential. Understanding the person’s experiences and thoughts on the food guide can help to enhance the education provided and give meaning (Lapum et al. 2020). In dietetic practice we place a high value on and evidence-based approach and may lose sight of the human aspect of diet education. Many chronic diseases can be improved with diet modification and being aware of some bias in our resources is crucial to supporting patients effectively.

This video clip does an excellent job of explaining this important aspect of nutrition education for vulnerable groups: Yasmin Khatau reflecting on the Canada’s Food Guide 2019 from a cultural perspective (from Lapum et al. 2020)

https://youtu.be/3HsvTHKp2rA

References:

Dietitians of Canada. (2021). Nutrition Month 2021. https://www.dietitians.ca/Advocacy/Nutrition-Month/Nutrition-Month-2021 Canada

Health Canada. (2020, October 14). Canada’s food guide. Cultures, food, traditions and healthy eating. https://food-guide.canada.ca/en/healthy-eating-recommendations/enjoy-your-food/cultures-food-traditions-and-healthy-eating/

Lapum, J., St. Amant, O., Garcia, W., Seto Nielson, L., Rahman, R. (2020). Interpreting Canada’s 2019 Food Guide and Food Labelling for Health Professionals. PressBooks. https://ecampusontario.pressbooks.pub/foodguide/chapter/cultural-relevance/