bellissima bonta

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3/17/11

The Food Police?

I thought I was going to love "Tanzania Free Time". Let's be honest, I am a free spirit in regards to keeping time. In Tanzania, they rule their time based on the placement of the sun. Appointments happen as they come. Even if an appointed time is set, the appointment may start late by an hour or more. For them, this is 'no problem' (hakuna matata, hakuna shida). The best part is there are no clocks. They laugh at the mzungus (foreigners) wearing watches like us Arizona folk laugh at the tourists wearing shorts in January (it's cold to us in that 65-70 degree weather!). Yet, since there are no clocks, time is subjective.
Does the sun say 12:30 or 11:30? Based on the shadow of the shack, it looks like 3:00pm or is it 1 hour after the rooster's first crow?
I really thought I was going to relish in the Tanzania Free Time life. My dad will be proud to know that I am a Mzungu Time (by the clock) girl at heart. While I might have a problem with being on time (that I strangely suspect will greatly improve as I return to the states), I am abnormally organized. The TFT people, as we call it here, just fly by the seat of their pants: including with my internship placement. Argh.

They do understand our culture and try to be respectful to the best of their ability. It would be the same as if you tried to have patience with going to see a movie and do dinner on a Saturday night with your good Tanzanian friend as you are waiting for now 70 minutes. I have been getting my internship goals accomplished by pleading and begging: aka being a mzungu nag. Yet the real frustration is they do not understand my internship.

I have been harboring a huge amount of frustration as I face this cultural and language barrier. In addition to those barriers, however, is the barrier of what a dietitian is. All RDs (registered dietitians) face this in the states. We are daily competing with the next Joe Schmoe who woke up one day and while eating breakfast said, "Hey. I think I'm an expert at this. I'm going to call myself a nutritionist." Worse, there are those 'nutrition experts' out there who DID go to some sort of training. Unfortunately for them, their training did not consist of evidence-based information and little do they know, the chances are great that that same Joe Schmoe was having lunch and said, "Hey. I think I'll make a school and give people pieces of paper that say they are nutrition experts too."

Now anyone can argue that a degree from a university is just a piece of paper. This is why after learning about the details of the enteral and parenteral feeding worlds, the necessities of the food cost analysis, the stages of transferrin depletion, and exactly why phosphorylation in glycolysis is important to pay attention to we take the information from that piece of paper and we practice on real people during our dietetic internship. Even better, we must complete that lovely internship and then pass an exam that encompasses all components of the dietetic field (community nutrition, clinical nutrition, and food service management) in order to wake up one day and say, "WAHOO! I THINK I AM A DIETITIAN!" 

I'm very passionate about health, particularly the nutrient side of it. I am so passionate that I have zero interest in being a nurse or a physician because they don't get to focus on the fun stuff enough, nor do they learn enough of the fun nutrition details (that's right I think it's fun). I am nothing close to a doctor, but I am a very good supplement for him or her. In a hospital setting, I make a very strong asset to the team in assessing the patient's needs and care plan. Yet, I do not know how to say this in kiswahili! Dietitians do not exist out here. I may possibly be the most knowledgeable in nutrition in the town of Moshi, although I hope I'm wrong. I knew this career field did not exist here before coming. It is a fairly new career field within the United States. I did not, however, anticipate that it would be such a hard concept to grasp. 

Today I went to an HIV/AIDS center. It was a great place to be. They focus on four components: testing, prevention education, self & community care, and treatment. I had a million and one nutrition questions to ask. What advice do you give to feed them? (The answer: eat enough). How do you assess the HIV+ children's diets? (The answer was interesting: they asked the parents what they thought their child was missing, then doctors, nurses, and 'health officers' assessed and they created a loan program for that family to start a business and make enough money to provide food for their child. I really liked this a lot, and I felt I could contribute greatly to this program if I had more time to work here. I can and will continue to contribute from home.) It was great to see how the operations of that type of clinic are run in this country. It was wonderful to see confident empowered women and men supporting equality and health. I wanted to jump in and revamp everything today, but I remembered the culture: they don't move quick here and, like any culture, they're not completely open to change. The number one lesson I've learned here that I know I can take with me is that you don't walk into any sort of structure and (unless asked to do so) completely redirect its structure. Instead, you find what works and slowly tweak that. It shows them that your change is not bad and allows you the opportunity to change more, over time, with minimal rebellion.

Needless to say, I was pumped after today's rotation. I went into the office and did a little more mzungu nagging: Can I go here? Can you set up a rotation there? Of course, their first language is kiswahili so that is the language they converse in with each other as I am speaking to the staff. Lucky for me, I am a surprisingly fast learner of different languages so this time I picked up on some key words of the conversation. I think they thought I was some sort of freakishly passionate chef (doing an internship?!?!)! As I'm suggesting these rotations and pushing to get into them, I hear them say, "They don't have kitchens there; there is no food at that site."

I interjected immediately. Although I've already said this multiple times while I've been here, I repeated my plea. Now I knew to specify the connection with kitchen and hospital as I know that's what they were talking about. They looked at me with bewilderment: What else could you have done there? Ok folks, there are many dietitians that work in kitchens - in hospitals too, and I have definitely placed myself in those positions here as I learn how the school meal is prepared, etc. However, dietitians are not paid mom's who tell you what to eat and police your food. They were shocked when I said (mind you I've said it all before) that I read lab values of my patients, gave recommendations to the physicians on how best to feed the patient, assessed their physical well-being based on how well-nourished they are AND could give a very well-educated assessment on whether I would prescribe additional nutrients or suggest avoiding such. They were amazed to hear that I worked next to doctors and nurses and helped them form their decisions on their treatment plan. They were dumbfounded that in America, it is my position that will give the research-backed advice on feeding technique and what to put in that tube going into their tummy or vein. They were astonished when I told them I have worked in the ICU for neonates, pediatrics, and adults. 

I really overestimated where I was going. I knew the role 'dietitian' did not exist. I knew within my own country many people have a misunderstanding of what it is we do, yet somehow I never anticipated that they would not take me seriously when I said I am a health professional. I had no idea (now I do thanks to my kiswahili lessons) that they thought I was just an overly passionate and annoying cook. Ironically, I am the opposite of the food police. Come on y'all, I'm from Philly. There is no way I am not breaking the health-rule every now and then for a proper Philly cheesesteak and an ice-cold Yuengling. I do have a brain for health. I know nutrients. I am great with kids, and they respond to me. And, for those adults who want to get healthy, I am great at being compassionate yet tough and helping them to change their lifestyle behaviors. I have come to this country to donate my knowledge and my abilities, yet it has been an everyday up-hill struggle to do so. Today, I finally got through to them! They instantly got on the phone and made the appointments - yes, made them, I did not have to give them the number and say I am going here and you need to call because they cannot understand my accent over the phone. Tomorrow I am going to work with a doctor! Jackpot! Tomorrow was going to be my day to go into town and plead for businesses to join the bandwagon for creating a school foodservice organization here; that will wait for the weekend. I am going to work in the Mwenzi Medical Center. I am going to work with the psychiatric department (it is the only department that gets food - I really would like to know what they do with their other inpatients). This is going to be wild.

1 comment:

  1. hahaha "Hey, I think I'm an expert at this!"

    ... sometimes I feel like dad has those moments in the morning... except sometimes, he can be freakishly smart about topics.

    anyway love you! keep your head up =] I'm so proud of you!!!!!!!

    ReplyDelete